ALLEGHENY COLLEGE FINANCIAL AID OFFICE
Dependent Student Verification Statement Allegheny College 2014-2015 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, 2014 through June 30, 2015 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, 2014 and June 30, 2015 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
Parent 1
N/A
Will be Enrolled at least Half Time (Yes or No) Y
N
Sibling
Y
N
Sibling
Y
N
Y
N
Parent 2
N/A
2. IRS Data Retrieval Tool or 2013 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 for both parents and student. 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 2-3 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. 2013 Income and Tax Forms
Check here if you (the parents) filed a tax extension. Submit a copy of the IRS tax extension form 4868 and copies of all your 2013 W-2s with this verification statement.
Check here if you (the parents) are not required to file a 2013 U.S. Federal Tax Return. Please complete the ‘Parent Statement of Non-Filing’ form (available at our website www.allegheny.edu/parentnonfiling). Return ‘Parent Statement of Non-Filing’ form and copies of all 2013 W-2s with this Verification Statement.
Check here if you (the student) will not and are not required to file a 2013 U.S. Federal Tax Return.
List below student’s employer(s) and any income student received in 2013 only if a return will not be filed.
List sources of all 2013 Student Income (Employer) – submit copies of all 2013 W-2s
Total Amount
2013 Amount
2013 W-2s provided (Circle Yes or No)
$
Y/N
$
Y/N
$
Y/N
$
Check here if you (the student) filed a tax extension. Submit a copy of the IRS tax extension form 4868 and copies of all 2013 W-2s with this verification statement.
4. Untaxed Income – Enter amounts received in 2013 for parents and all dependent children (including student) in spaces provided below. Enter “0” if below items are not applicable a) SNAP (food stamps)
$__________
b) Child support received
$__________
c) Untaxed Workman’s Compensation
$__________
d) Untaxed Disability (not SSDI)
$__________
e) Payment(s) to Tax Deferred Retirement Plan
$___________
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)
f) Other:_____________________________
$___________
5. Parent’s Child Support Paid 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. 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
_________________________________________ Date
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, 2014 through June 30, 2015 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, 2014 and June 30, 2015 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
Parent 1
N/A
Will be Enrolled at least Half Time (Yes or No) Y
N
Sibling
Y
N
Sibling
Y
N
Y
N
Parent 2
N/A
2. IRS Data Retrieval Tool or 2013 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 for both parents and student. 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 2-3 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. 2013 Income and Tax Forms
Check here if you (the parents) filed a tax extension. Submit a copy of the IRS tax extension form 4868 and copies of all your 2013 W-2s with this verification statement.
Check here if you (the parents) are not required to file a 2013 U.S. Federal Tax Return. Please complete the ‘Parent Statement of Non-Filing’ form (available at our website www.allegheny.edu/parentnonfiling). Return ‘Parent Statement of Non-Filing’ form and copies of all 2013 W-2s with this Verification Statement.
Check here if you (the student) will not and are not required to file a 2013 U.S. Federal Tax Return.
List below student’s employer(s) and any income student received in 2013 only if a return will not be filed.
List sources of all 2013 Student Income (Employer) – submit copies of all 2013 W-2s
Total Amount
2013 Amount
2013 W-2s provided (Circle Yes or No)
$
Y/N
$
Y/N
$
Y/N
$
Check here if you (the student) filed a tax extension. Submit a copy of the IRS tax extension form 4868 and copies of all 2013 W-2s with this verification statement.
4. Untaxed Income – Enter amounts received in 2013 for parents and all dependent children (including student) in spaces provided below. Enter “0” if below items are not applicable a) SNAP (food stamps)
$__________
b) Child support received
$__________
c) Untaxed Workman’s Compensation
$__________
d) Untaxed Disability (not SSDI)
$__________
e) Payment(s) to Tax Deferred Retirement Plan
$___________
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)
f) Other:_____________________________
$___________
5. Parent’s Child Support Paid 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. 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
_________________________________________ Date
Financial Aid Office 520 North Main St. Meadville, PA 16335
Fax: (814) 332-2349 Email: [email protected]
