2009 2010 Verification Worksheet
2009-2010 Verification Worksheet Dependent
FORM APPROVED
OMB NO. 1845-0041
U.S. Department
Federal Student Aid Programs
of Education
Your application was selected for review in a process called
What you should do
“Verification.” In this process, your school will be comparing
1. Collect your and your parent(s)’ financial documents (signed
information from your application with signed copies of your
Federal income tax forms, W-2 forms, etc.).
and your parent(s)’ 2008 Federal tax forms, or with W-2 forms or
2. Talk to your financial aid administrator if you have questions
other financial documents. The law says we have the right to ask
about completing this worksheet.
you for this information before awarding Federal aid. If there are
3. Complete and sign the worksheet—you and at least one
differences between your application information and your finan-
parent.
cial documents, you or your school may need to make corrections 4. Submit the completed worksheet, tax forms, and any other
electronically or by using your Student Aid Report (SAR).
documents your school requests to your financial aid
administrator.
Complete this verification form and submit it to your financial aid 5. Your financial aid administrator will compare information on
administrator as soon as possible, so that your financial aid won’t
this worksheet and any supporting documents with the
be delayed. Your financial aid administrator will help you.
information you submitted on your application. You or your
school may need to make corrections electronically or by
using your SAR.
A. Student Information
Last name
First name
M.I.
Social Security Number
Address (include apt. no.)
Date of birth
City
State
ZIP Code
Phone number (include area code)
B. Family Information
List the people in your parent(s)’ household, including:
• yourself and your parent(s) (including stepparent) even if you don’t live with your parents, and
• your parents’ other children, even if they don’t live with your parent(s), if (a) your parents will provide more than half of their
support from July 1, 2009 through June 30, 2010, or (b) the children would be required to provide parental information when
applying for Federal Student Aid, and
• 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, 2009 through June 30, 2010.
Write the names of all household members in the space(s) below. Also write in the name of the college for any household member,
excluding your parent(s), who will be attending at least half time between July 1, 2009 and June 30, 2010, and will be enrolled in a
degree, diploma, or certificate program. If you need more space, attach a separate page.
Full Name
Age
Relationship
College
Missy Jones (example)
18
Sister
Central University
Self
According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection
is 1845-0041. The time required to complete this information collection is estimated to average twelve minutes, including the time to review instructions, search existing data resources, gather the data needed, and complete and re-
view the information collection. If you have any comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: US Department of Education, Washington, DC 20202-5345.
C. Student’s Tax Forms and Income Information (all applicants)
Dependent
1. Check only one box below. Tax returns include the 2008 IRS Form 1040, 1040A, 1040EZ, a tax return from Puerto
Rico or a foreign income tax return. If you did not keep a copy of your tax return, request a copy from your tax preparer
or request an Internal Revenue Service form that lists tax account information.
Check here if you are attaching a signed copy of your tax return.
Check here if a signed tax return will be submitted to the school by ______________________(date).
Check here if you will not file and are not required to file a 2008 U.S. Income Tax Return.
2. Funds received for child support and other untaxed income. (See Question 47 of the Free Application for
Federal Student Aid (FAFSA).)
Sources of Untaxed Income
2008 Amount
Sources of Untaxed Income 2008 Amount
a. Child Support
$
d.
$
b. Workman’s Compensation
$
e.
$
c. Untaxed Pensions
$
f.
$
3. If you did not file and are not required to file a 2008 Federal income tax return, list below your employer(s) and any
income received in 2008 (use the W-2 form or other earnings statements if available).
Sources
2008 Income
$
$
$
D. Parent(s)’ Tax Forms and Income Information
1. Check only one box below. Tax returns include the 2008 IRS Form 1040, 1040A, 1040EZ, a tax return from Puerto Rico or a
foreign income tax return. If your parent(s) did not keep a copy of their tax return, request a copy from the tax preparer or request
an Internal Revenue Service form that lists tax account information.
Check here if you are attaching a signed copy of your parents’ tax return(s).
Check here if a signed tax return(s) will be submitted to the school by ______________________(date).
Check here if your parent(s) will not file and are not required to file a 2008 U.S. Income Tax Return.
2. Funds received for child support and other untaxed income. (See Question 95 of the FAFSA.)
Sources of Untaxed Income
2008 Amount
Sources of Untaxed Income 2008 Amount
a. Child Support
$
d.
$
b. Workman’s Compensation
$
e.
$
c. Untaxed Pensions
$
f.
$
3. If your parent(s) did not file and are not required to file a 2008 Federal income tax return, list below your parent(s)’
employer(s) and any income they received in 2008 (use the W-2 form or other earnings statements if available).
Sources
2008 Income
$
$
$
E. Sign this Worksheet
Each person signing this form certifies that all the information reported
WARNING: If you purposely give false or misleading
on it is complete and correct. The student and at least one parent must
information on this worksheet, you may be fined, be
sign and date.
sentenced to jail, or both.
Student
Date
Parent
Date
Do not mail this worksheet to the Department of Education. Submit this worksheet to your
Financial Aid Administrator at your school. Don’t forget to sign your tax forms.
