ALLEGHENY COLLEGE FINANCIAL AID OFFICE
Dependent Student Verification Statement Allegheny College 2015-2016 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, 2015 through June 30, 2016 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, 2015 and June 30, 2016 and will be enrolled in a degree, diploma or certificate program. If you need more space, please attach a separate page. List EVERYONE Who Lives Your Home
2)
Age
2014 Parent Income Verification
Relationship To Student
If They Attend College, List Name of College
Self
Allegheny College
Parent 1
N/A
Parent 2
N/A
Will be Enrolled in at least Half Time (Yes or No) Y N
Sibling
Y
N
Sibling
Y
N
Y
N
(Must Check One)
Check here if you, the parent(s), have or will complete your 2014 Tax Return by the IRS tax filing deadline of April 15, 2015. Update the FAFSA with accurate 2014 tax return information by utilizing the IRS Data Retrieval Tool (DRT). IRS Data Retrieval Tool instructions can be found at www.allegheny.edu/apply-finaid. 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 2-3 weeks after filing All Paper Tax Filers – Data will be available 8-11 weeks after filing If you do not utilize the IRS Data Retrieval Tool on the FAFSA, you must request a 2014 Tax Return Transcript from the IRS and send it to the Financial Aid office. This process will take 1-2 weeks longer than using the IRS Data Retrieval Tool. To request a tax transcript, please visit the website www.irs.gov. Instructions are available at www.allegheny.edu/apply-finaid.
Check here if you, the parent(s), will file a 2014 tax extension. Please submit a copy of your IRS tax extension form 4868 and copies of all your 2014 W-2s with this verification statement. Once your 2014 taxes are completed, you must verify income using the IRS Data Retrieval Tool on the FAFSA or ordering a 2014 Tax Return Transcripts directly from the IRS (instructions can be found at www.allegheny.edu/apply-finaid).
Check here if you, the parent(s), are not required to file a 2014 U.S. Federal Tax Return. Please complete and return a ‘Parent Statement of Non-Filing’ form (available at www.allegheny.edu/parentnonfiling) and copies of all 2014 W-2s with this Verification Statement. Visit www.irs.gov/publications/p501/ar02.html#en_US_2013_publink1000220720 to view tax filing requirements and thresholds.
3)
2014 Student Income and Tax Forms
Check here if you, the student, have or will complete your 2014 Tax Return by the IRS tax filing deadline of April 15, 2015. Update the FAFSA with accurate 2014 tax return information by utilizing the IRS Data Retrieval Tool (DRT). IRS Data Retrieval Tool instructions can be found at www.allegheny.edu/apply-finaid. 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 2-3 weeks after filing All Paper Tax Filers – Data will be available 8-11 weeks after filing If you do not utilize the IRS Data Retrieval Tool on the FAFSA, you must request a 2014 Tax Return Transcript from the IRS and send to the Financial Aid office. This process will take 1-2 weeks longer than using the IRS Data Retrieval Tool. To request a tax transcript, please visit the website www.irs.gov. Instructions are available at www.allegheny.edu/apply-finaid. Check here if you (the student) will not and are not required to file a 2014 U.S. Federal Tax Return.
(Must Check One)
If not filing a tax return, student must list their total income earned as shown on 2014 W-2s (attach copies of student’s W-2s). $________________ (Do Not Leave a Blank Space - Enter ‘n/a’ or ‘zero’ if not applicable) If student is not filing a tax return but earned money without receiving a W-2 (i.e. babysitting), student must list their income. $________________ (Do Not Leave a Blank Space - Enter ‘n/a’ or ‘zero’ if not applicable)
Check here if you (the student) filed a tax extension. Submit a copy of the IRS tax extension form 4868 and copies of all 2014 W-2s with this verification statement.
4)
Untaxed Income – Enter amounts received in 2014 for parents and all dependent children (including student) in spaces provided below. Do Not Leave Blank Spaces - Enter ‘n/a’ or ‘zero’ if any items below are not applicable a)
SNAP (food stamps)
b)
Housing, food, or living allowances (clergy/military) $_______
c)
Child support received
$_______
d)
Veterans non-education benefits
$_______
e)
Untaxed Workman’s Compensation
$_______
f)
Untaxed Disability (not Social Security Disability)
$_______
g)
Payment(s) to Tax Deferred Retirement Plan
$_______
h)
Total amounts from all parent W-2 wage statements in boxes 12a-12d with codes D, E, F, G, H, or S. (Amounts will be shown in the highlighted box on the right) Other:______________________________ $_________
5)
$_______
Example W-2
Parent’s Child Support Paid (Do Not Leave Blank Spaces - enter ‘n/a’ or ‘zero’ if not applicable) 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: ________________________________________
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, 2015 through June 30, 2016 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, 2015 and June 30, 2016 and will be enrolled in a degree, diploma or certificate program. If you need more space, please attach a separate page. List EVERYONE Who Lives Your Home
2)
Age
2014 Parent Income Verification
Relationship To Student
If They Attend College, List Name of College
Self
Allegheny College
Parent 1
N/A
Parent 2
N/A
Will be Enrolled in at least Half Time (Yes or No) Y N
Sibling
Y
N
Sibling
Y
N
Y
N
(Must Check One)
Check here if you, the parent(s), have or will complete your 2014 Tax Return by the IRS tax filing deadline of April 15, 2015. Update the FAFSA with accurate 2014 tax return information by utilizing the IRS Data Retrieval Tool (DRT). IRS Data Retrieval Tool instructions can be found at www.allegheny.edu/apply-finaid. 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 2-3 weeks after filing All Paper Tax Filers – Data will be available 8-11 weeks after filing If you do not utilize the IRS Data Retrieval Tool on the FAFSA, you must request a 2014 Tax Return Transcript from the IRS and send it to the Financial Aid office. This process will take 1-2 weeks longer than using the IRS Data Retrieval Tool. To request a tax transcript, please visit the website www.irs.gov. Instructions are available at www.allegheny.edu/apply-finaid.
Check here if you, the parent(s), will file a 2014 tax extension. Please submit a copy of your IRS tax extension form 4868 and copies of all your 2014 W-2s with this verification statement. Once your 2014 taxes are completed, you must verify income using the IRS Data Retrieval Tool on the FAFSA or ordering a 2014 Tax Return Transcripts directly from the IRS (instructions can be found at www.allegheny.edu/apply-finaid).
Check here if you, the parent(s), are not required to file a 2014 U.S. Federal Tax Return. Please complete and return a ‘Parent Statement of Non-Filing’ form (available at www.allegheny.edu/parentnonfiling) and copies of all 2014 W-2s with this Verification Statement. Visit www.irs.gov/publications/p501/ar02.html#en_US_2013_publink1000220720 to view tax filing requirements and thresholds.
3)
2014 Student Income and Tax Forms
Check here if you, the student, have or will complete your 2014 Tax Return by the IRS tax filing deadline of April 15, 2015. Update the FAFSA with accurate 2014 tax return information by utilizing the IRS Data Retrieval Tool (DRT). IRS Data Retrieval Tool instructions can be found at www.allegheny.edu/apply-finaid. 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 2-3 weeks after filing All Paper Tax Filers – Data will be available 8-11 weeks after filing If you do not utilize the IRS Data Retrieval Tool on the FAFSA, you must request a 2014 Tax Return Transcript from the IRS and send to the Financial Aid office. This process will take 1-2 weeks longer than using the IRS Data Retrieval Tool. To request a tax transcript, please visit the website www.irs.gov. Instructions are available at www.allegheny.edu/apply-finaid. Check here if you (the student) will not and are not required to file a 2014 U.S. Federal Tax Return.
(Must Check One)
If not filing a tax return, student must list their total income earned as shown on 2014 W-2s (attach copies of student’s W-2s). $________________ (Do Not Leave a Blank Space - Enter ‘n/a’ or ‘zero’ if not applicable) If student is not filing a tax return but earned money without receiving a W-2 (i.e. babysitting), student must list their income. $________________ (Do Not Leave a Blank Space - Enter ‘n/a’ or ‘zero’ if not applicable)
Check here if you (the student) filed a tax extension. Submit a copy of the IRS tax extension form 4868 and copies of all 2014 W-2s with this verification statement.
4)
Untaxed Income – Enter amounts received in 2014 for parents and all dependent children (including student) in spaces provided below. Do Not Leave Blank Spaces - Enter ‘n/a’ or ‘zero’ if any items below are not applicable a)
SNAP (food stamps)
b)
Housing, food, or living allowances (clergy/military) $_______
c)
Child support received
$_______
d)
Veterans non-education benefits
$_______
e)
Untaxed Workman’s Compensation
$_______
f)
Untaxed Disability (not Social Security Disability)
$_______
g)
Payment(s) to Tax Deferred Retirement Plan
$_______
h)
Total amounts from all parent W-2 wage statements in boxes 12a-12d with codes D, E, F, G, H, or S. (Amounts will be shown in the highlighted box on the right) Other:______________________________ $_________
5)
$_______
Example W-2
Parent’s Child Support Paid (Do Not Leave Blank Spaces - enter ‘n/a’ or ‘zero’ if not applicable) 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: ________________________________________
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]
