Student ID#: ______

Name: ______

2017-2018 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 2017–2018 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

______

Student’s Last Name Student’s First Name Student’s M.I. Student’s Social Security Number

______

Student’s Street Address (include apt. no.) Student’s Date of Birth

______

City State Zip Code Student’s Email Address

______

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, 2017 through June 30, 2018; 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, 2017 through June 30, 2018

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, 2017 through June 30, 2018 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 Time
Marty Jones(example) / 28 / Brother / 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 2015 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) filed, or will file, an amended 2015 IRS Tax Return, you must provide a tax transcript of your original tax return, along with the IRS tax account transcript for your amended tax return. Call the IRS at 1-800-908-9946 to request a transcript/s for 2015 or request online at: http://www.irs.gov/Individuals/Get-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 2015 income tax return with the IRS. Attach copies of all 2015 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. In addition, you must also provide a Verification of Non-filing Letter, which you can obtain from the IRS. Call the IRS at 1-800-908-9946 to request a Verification of Non-filing Letter for 2015 or request online at: http://www.irs.gov/Individuals/Get-Transcript

Employer’s Name / 2015 Amount Earned / IRS W-2 Attached?
Suzy’s Auto Body Shop (example) / $2,000.00 / Yes

I, ______(Student Name), certify that I have not filed and am not required to file a 2015 Income Tax Return.

I, ______(Spouse Name), certify that I have not filed and am not required to file a 2015 Income Tax Return.

D.  Certification and Signature

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.

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.

______

Student’s Signature Date

______

Spouse’s Signature (Only required if completing Section C-Non-Tax Filer Statement) 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: