ALLEGHENY COLLEGE FINANCIAL AID OFFICE
Independent Student Verification Statement Allegheny College 2016-2017 Student______________________________________________Allegheny Student I.D. Number___________________ Address__________________________________________________________________________________________ Street/P.O. Box City State Zip Code Cell Phone Number (_____)____________________Home Phone Number (_____)____________________ Email Address__________________________________________________
1. YOUR HOUSEHOLD SIZE AND NUMBER IN COLLEGE List the name, age, and relationship of each person who is a member of your household. Include yourself, your spouse (if married) and your dependent children (if applicable) if you will provide at least half of their support during the 2016-2017 academic year (July 1, 2016 through June 30, 2017). For any household members who will be attending college during 2016-2017, please indicate where they will enroll. Name
Age
Relationship
Self
2. Student and Spouse (if married) Income Verification
If Attending College, List Name of College
Allegheny College
Will be Enrolled at least Half Time (Yes or No) Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
(Must Check One)
Check here if you and your spouse (if married), have or will complete your 2015 Tax Return by the IRS tax filing deadline of April 15, 2016. Update the FAFSA with accurate 2015 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 (in most cases) - 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 2015 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 and your spouse (if married), will file a 2015 tax extension. Please submit a copy of your IRS tax extension form 4868 and copies of all your 2015 W-2s with this verification statement. • Once your 2015 taxes are completed, you must verify income using the IRS Data Retrieval Tool on the FAFSA or ordering a 2015 Tax Return Transcripts directly from the IRS (instructions can be found at www.allegheny.edu/apply-finaid).
Check here if you and your spouse (if married), are not required to file a 2015 U.S. Federal Tax Return. Please complete and return a ‘Student Statement of Non-Filing’ form (available at www.allegheny.edu/parentnonfiling) and copies of all 2015 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.
Untaxed Income – Enter amounts received in 2015 for you, your spouse (if married), and all dependent children 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 12a12d with codes D, E, F, G, H, or S. (Amounts will be shown in the highlighted box on the right) Other:______________________________ $_________
4. Child Support Paid
Example W-2
(Do Not Leave Blank Spaces – enter ‘n/a’ or ‘zero’ if not applicable)
Child support paid by you or your spouse (if married) to other children not living in your household: $________________________List recipients: __________________List beneficiaries: __________________________ Signature of person paying child support: ____________________________________
5. Sign this Worksheet By signing this worksheet, we certify that all the information reported on it is complete and correct.
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 Date
_________________________________________________________________ __________________________________ Spouse Signature Required (if married) Date
Fax: (814) 332-2349 Email: [email protected] Allegheny College Financial Aid Office 520 North Main St. Meadville, PA 16335
1. YOUR HOUSEHOLD SIZE AND NUMBER IN COLLEGE List the name, age, and relationship of each person who is a member of your household. Include yourself, your spouse (if married) and your dependent children (if applicable) if you will provide at least half of their support during the 2016-2017 academic year (July 1, 2016 through June 30, 2017). For any household members who will be attending college during 2016-2017, please indicate where they will enroll. Name
Age
Relationship
Self
2. Student and Spouse (if married) Income Verification
If Attending College, List Name of College
Allegheny College
Will be Enrolled at least Half Time (Yes or No) Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
(Must Check One)
Check here if you and your spouse (if married), have or will complete your 2015 Tax Return by the IRS tax filing deadline of April 15, 2016. Update the FAFSA with accurate 2015 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 (in most cases) - 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 2015 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 and your spouse (if married), will file a 2015 tax extension. Please submit a copy of your IRS tax extension form 4868 and copies of all your 2015 W-2s with this verification statement. • Once your 2015 taxes are completed, you must verify income using the IRS Data Retrieval Tool on the FAFSA or ordering a 2015 Tax Return Transcripts directly from the IRS (instructions can be found at www.allegheny.edu/apply-finaid).
Check here if you and your spouse (if married), are not required to file a 2015 U.S. Federal Tax Return. Please complete and return a ‘Student Statement of Non-Filing’ form (available at www.allegheny.edu/parentnonfiling) and copies of all 2015 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.
Untaxed Income – Enter amounts received in 2015 for you, your spouse (if married), and all dependent children 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 12a12d with codes D, E, F, G, H, or S. (Amounts will be shown in the highlighted box on the right) Other:______________________________ $_________
4. Child Support Paid
Example W-2
(Do Not Leave Blank Spaces – enter ‘n/a’ or ‘zero’ if not applicable)
Child support paid by you or your spouse (if married) to other children not living in your household: $________________________List recipients: __________________List beneficiaries: __________________________ Signature of person paying child support: ____________________________________
5. Sign this Worksheet By signing this worksheet, we certify that all the information reported on it is complete and correct.
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 Date
_________________________________________________________________ __________________________________ Spouse Signature Required (if married) Date
Fax: (814) 332-2349 Email: [email protected] Allegheny College Financial Aid Office 520 North Main St. Meadville, PA 16335
