ALLEGHENY COLLEGE FINANCIAL AID OFFICE
Dependent Student Verification Statement Allegheny College 2013-2014 Student______________________________________________Allegheny Student I.D. Number___________________ Address__________________________________________________________________________________________ Street/P.O. Box City State Zip Code Cell Phone Number (_____)_______________________ Home Phone Number (_____)________________________ Email Address__________________________________________________
1. Family Information List the people in your parents’ household and include: yourself and your parents (stepparent) your parents’ other children even if they don’t live with your parent(s) if your parents will provide more than half their support other people if they now live with your parents, and your parents provide more than half of their support and will continue to provide more than half of their support from July 1, 2013 through June 30, 2014 Write the names of all household members in the space(s) below. Also write in the name of the college for any family member (excluding parents) who will be attending college at least half-time between July 1, 2013 and June 30, 2014 and will be enrolled in a degree, diploma or certificate program. If you need more space, attach a separate page. List EVERYONE Who Lives In Your Home
Age
Relationship To Student
If They Attend College, List Name of College
Self
Allegheny College
Will be Enrolled at least Half-Time (Yes or No) Y
N
Sibling
Y
N
Sibling
Y
N
Y
N
Y
N
Custodial Parent
N/A
Custodial Parent/Stepparent
N/A
2. IRS Data Retrieval Tool or 2012 Tax Transcript The FAFSA may be updated with the tax return information by utilizing the IRS Data Retrieval Tool. The IRS Data Retrieval Tool inputs the tax return information into the FAFSA directly from the IRS. We strongly encourage all families to utilize the IRS Data Retrieval Tool, if applicable. IF YOU DO NOT UTILIZE THE IRS DATA RETRIEVAL TOOL, YOU MUST REQUEST THE TAX TRANSCRIPT FROM THE IRS TO SEND TO THE FINANCIAL AID OFFICE. For more instructions on how to use the IRS Data Retrieval Tool, please visit our website www.allegheny.edu/apply-finaid. Availability of the IRS Data Retrieval Tool is as follows:
Electronic Tax Filers (refunds or no tax payment due) – Data will be available 2-3 weeks after filing Electronic Tax Filers (tax payment due) – Data will be available 6-8 weeks after filing All Paper Tax Filers – Data will be available 8-11 weeks after filing
To request a tax transcript, please visit the website www.irs.gov or request the transcript by calling 1-800-9089946. It could take another two to three weeks to receive the tax transcript by requesting it from the IRS.
3. Tax Forms and W-2 Wage Statements Parents and students must include a copy of their 2012 W-2 wage statements issued from an employer. If a tax extension is being filed, include the request for an extension (Form 4868) along with W-2’s. Only if your parents are not required to file a 2012 Federal Tax Return, please complete a Parent Statement of Non-Filing form (available at our website www.allegheny.edu/parentnonfiling) and send it with this Verification Statement. Only if you (student) did not file and are not required to file a 2012 Federal income tax return, list below your employer(s) and any income you received in 2012. Check here if you (student) will not file and are not required to file a 2012 U.S. federal income tax return. Sources of all Student Income (Employer)
2012 Amount
IRS W-2 Provided? Y / N
$ $
Total Amount
$
4. Parents’ Untaxed Income Amounts received for child support and other untaxed income. List amounts received for parents and all dependent children, including yourself. DO NOT LEAVE BLANK IF THE ANSWER IS ZERO, ENTER "0" IN THE SPACE PROVIDED Sources of Untaxed Income
2012 Amount
Sources of Untaxed Income
2012 Amount
a. SNAP (food stamps)
$
d. Workman’s Comp.
$
b. Child Support Received
$
e. Other:
$
c. Payment to tax deferred retirement plan
$
f. Other:
$
5. Student’s Federal Work Study Earnings and Parent’s Child Support Paid List the amount of need-based federal work-study earnings student received in 2012: $______________________ Child support paid by parents listed, under Section I above, to other children not living in the parents' household: $________________________List recipients: __________________List beneficiaries: __________________________ Signature of person paying child support: ____________________________________
6. Scholarships Do you expect to receive a scholarship or other gift/benefit aid awarded from a source other than Allegheny College for 2013-2014? ____YES ____NO If yes, please list amounts separately: $_______________________ $_______________________ $_______________________ Sources: __________________________________
___________________________________
7. Sign this Worksheet By signing this worksheet, we certify that all the information reported on it is complete and correct. At least one parent must sign.
_________________________________
WARNING: If you purposely give false or misleading information on this worksheet, you may be fined, be sentenced to jail, or both.
_____________________________________________________________ Student Signature Required (Parent/stepparent may not sign for student)
_________________________________________ Date
_____________________________________________________________ Parent Signature Required
_________________________________________ Date
Allegheny College Financial Aid Office 520 North Main St. Meadville, PA 16335
Fax: (814) 332-2349 Email: [email protected]
1. Family Information List the people in your parents’ household and include: yourself and your parents (stepparent) your parents’ other children even if they don’t live with your parent(s) if your parents will provide more than half their support other people if they now live with your parents, and your parents provide more than half of their support and will continue to provide more than half of their support from July 1, 2013 through June 30, 2014 Write the names of all household members in the space(s) below. Also write in the name of the college for any family member (excluding parents) who will be attending college at least half-time between July 1, 2013 and June 30, 2014 and will be enrolled in a degree, diploma or certificate program. If you need more space, attach a separate page. List EVERYONE Who Lives In Your Home
Age
Relationship To Student
If They Attend College, List Name of College
Self
Allegheny College
Will be Enrolled at least Half-Time (Yes or No) Y
N
Sibling
Y
N
Sibling
Y
N
Y
N
Y
N
Custodial Parent
N/A
Custodial Parent/Stepparent
N/A
2. IRS Data Retrieval Tool or 2012 Tax Transcript The FAFSA may be updated with the tax return information by utilizing the IRS Data Retrieval Tool. The IRS Data Retrieval Tool inputs the tax return information into the FAFSA directly from the IRS. We strongly encourage all families to utilize the IRS Data Retrieval Tool, if applicable. IF YOU DO NOT UTILIZE THE IRS DATA RETRIEVAL TOOL, YOU MUST REQUEST THE TAX TRANSCRIPT FROM THE IRS TO SEND TO THE FINANCIAL AID OFFICE. For more instructions on how to use the IRS Data Retrieval Tool, please visit our website www.allegheny.edu/apply-finaid. Availability of the IRS Data Retrieval Tool is as follows:
Electronic Tax Filers (refunds or no tax payment due) – Data will be available 2-3 weeks after filing Electronic Tax Filers (tax payment due) – Data will be available 6-8 weeks after filing All Paper Tax Filers – Data will be available 8-11 weeks after filing
To request a tax transcript, please visit the website www.irs.gov or request the transcript by calling 1-800-9089946. It could take another two to three weeks to receive the tax transcript by requesting it from the IRS.
3. Tax Forms and W-2 Wage Statements Parents and students must include a copy of their 2012 W-2 wage statements issued from an employer. If a tax extension is being filed, include the request for an extension (Form 4868) along with W-2’s. Only if your parents are not required to file a 2012 Federal Tax Return, please complete a Parent Statement of Non-Filing form (available at our website www.allegheny.edu/parentnonfiling) and send it with this Verification Statement. Only if you (student) did not file and are not required to file a 2012 Federal income tax return, list below your employer(s) and any income you received in 2012. Check here if you (student) will not file and are not required to file a 2012 U.S. federal income tax return. Sources of all Student Income (Employer)
2012 Amount
IRS W-2 Provided? Y / N
$ $
Total Amount
$
4. Parents’ Untaxed Income Amounts received for child support and other untaxed income. List amounts received for parents and all dependent children, including yourself. DO NOT LEAVE BLANK IF THE ANSWER IS ZERO, ENTER "0" IN THE SPACE PROVIDED Sources of Untaxed Income
2012 Amount
Sources of Untaxed Income
2012 Amount
a. SNAP (food stamps)
$
d. Workman’s Comp.
$
b. Child Support Received
$
e. Other:
$
c. Payment to tax deferred retirement plan
$
f. Other:
$
5. Student’s Federal Work Study Earnings and Parent’s Child Support Paid List the amount of need-based federal work-study earnings student received in 2012: $______________________ Child support paid by parents listed, under Section I above, to other children not living in the parents' household: $________________________List recipients: __________________List beneficiaries: __________________________ Signature of person paying child support: ____________________________________
6. Scholarships Do you expect to receive a scholarship or other gift/benefit aid awarded from a source other than Allegheny College for 2013-2014? ____YES ____NO If yes, please list amounts separately: $_______________________ $_______________________ $_______________________ Sources: __________________________________
___________________________________
7. Sign this Worksheet By signing this worksheet, we certify that all the information reported on it is complete and correct. At least one parent must sign.
_________________________________
WARNING: If you purposely give false or misleading information on this worksheet, you may be fined, be sentenced to jail, or both.
_____________________________________________________________ Student Signature Required (Parent/stepparent may not sign for student)
_________________________________________ Date
_____________________________________________________________ Parent Signature Required
_________________________________________ Date
Allegheny College Financial Aid Office 520 North Main St. Meadville, PA 16335
Fax: (814) 332-2349 Email: [email protected]
