Student ID#: ______
Name: ______
2014-2015 Verification Worksheet for Independent Students
Jefferson College of Health Sciences’ Office of Financial Aid
101 Elm Avenue, SE Roanoke, VA 24013-2222
Phone: (540) 985-8267 Fax: (540) 224-6916 Email:
Your 2014–2015 Free Application for Federal Student Aid (FAFSA) was selected for review in a process called verification. The law says that before awarding Federal Student Aid, we may ask you to confirm the information you reported on your FAFSA. To verify that you provided correct information the financial aid administrator at your school will compare your FAFSA with the information on this worksheet and with any other required documents. If there are differences, your FAFSA information may need to be corrected. You must complete and sign this worksheet, attach any required documents, and submit the form and other required documents to the financial aid administrator at your school. Your school may ask for additional information. If you have questions about verification, contact your financial aid administrator as soon as possible so that your financial aid will not be delayed.
Jefferson College of Health Sciences’ Office of Financial Aid
101 Elm Avenue, SE Roanoke, VA 24013-2222
Phone: (540) 985-8267 Fax: (540) 224-6916 Email:
A. Independent Student’s Information
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Student’s Last Name Student’s First Name Student’s M.I. Student’s Social Security Number
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Student’s Street Address (include apt. no.) Student’s Date of Birth
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City State Zip Code Student’s Email Address
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Student’s Home Phone Number (include area code) Student’s Alternate or Cell Phone Number
B. Family Information
List the people in your household; include (a) yourself and your spouse, (b) your children, if you will provide more than half of their support from July 1, 2014 through June 30, 2015; and any other people if they now live with you, and you provide more than half of their support and will continue to do so from July 1, 2014 through June 30, 2015
Write the names of all household members; including yourself: Write in the name of the college for any family member, , other than your parent(s), who will be going to college at least half-time from July 1, 2014 through June 30, 2015 and will be enrolled in a degree, diploma, or certificate program. Attach a separate page for additional names. We may require documentation if we have reason to believe this information is incorrect.
Full Name / Age / Relationship / College / Will be Enrolled at Least Half TimeMarty Jones(example) / 28 / Wife / Central University / Yes
Self / Jefferson College of Health Sciences
C. Independent Student’s Income Tax Information to Be Verified
ALL TAX FILERS must submit an IRS transcript of all 2013 Federal Tax Returns or use the IRS Data Retrieval Tool, when completing the FAFSA, and do not change the information or submit a correction to the FAFSA by using the IRS Data Retrieval Tool, and do not change the information.
Important Note: If you (or your spouse, if married) filed, or will file, an amended 2013 IRS Tax Return, you must provide a tax transcript along with the IRS tax account transcript. Call the IRS at 1-800-908-9946 to request a transcript for 2013 or request online at: http://www.irs.gov/Individuals/Order-a-Transcript
NON-TAX FILERS must complete the section below if you, the student (and if married, your spouse), will not file and are not required to file a 2013 income tax return with the IRS. Attach copies of all 2013 W-2 forms issued to you (and, if married, to your spouse) by employers. List every employer even if the employer did not issue an IRS W-2 form. If more space is needed, attach a separate page with your name and student ID at the top.
Employer’s Name / 2013 Amount Earned / IRS W-2 Attached?Suzy’s Auto Body Shop (example) / $2,000.00 / Yes
D. SNAP and CHILD SUPPORT Information to Be Verified
1. Complete this section if someone in the student’s household (listed in Section B) received benefits from the Supplemental Nutrition Assistance Program or SNAP (formerly known as food stamps) any time during the 2012 or 2013 calendar years.
Check here if one of the people listed in section B received SNAP benefits in 2012-2013.
Check here if NO ONE in section B received SNAP benefits in 2012-2013.
2. Complete this section if you or your spouse, if married, paid child support in 2013.
Check here if student, if married, my spouse who is listed in Section B of this worksheet, paid child support in 2013.
Who Paid Child Support / Person to Whom Child Support was Paid / Name of Child for Whom Support Was Paid / Amount of Child Support Paid in 2013Marty Jones(example) / Chris Smith / Terry Jones / $6,000.00
E. Certification and Signature
I certify that all of the information reported on this worksheet is complete and correct. The student must sign this worksheet. If married, the spouse’s signature is optional.
By signing this form, I certify that all the information attested to is accurate and correct. Because this information may affect federal aid eligibility, intentionally giving false or misleading information may cause you to be fined up to $20,000.00, sent to prison, or both.
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Student’s Signature Date Spouse’s Signature (Optional) Date
Jefferson College of Health Sciences’ Office of Financial Aid
101 Elm Avenue, SE Roanoke, VA 24013-2222
Phone: (540) 985-8267 Fax: (540) 224-6916 Email: