2017-2018 Verification Worksheet Dependent

Your application was selected for review in a process called “verification”. During this process, Kettering may require additional information such as copies of your, and your parent(s)’, 2015 Federal tax return transcripts, W2 forms, and/or other financial documents. The law says that before awarding Federal Student Aid, we may ask you to confirm the information you and your parents reported on your FAFSA.

Complete this verification form and return it to your Financial Aid Officer as soon as

possible so your financial aid won’t be delayed.

The completed form can be returned to:

Mail:Kettering University

Office of Financial Aid

1700 University Avenue

Flint, MI 48504-6214

Fax:810-762-9807

  1. Student Information

______

Last NameFirst Name M.I.Student ID#

______

Address (include apt. #)Date of Birth

______

CityStateZip CodePhone Number (include area code)

  1. Family Information

Report family information for the parent with whom you filed the FAFSA. Attach additional sheets if necessary.

List all of the people in your parent(s)’ household, including:

  • Yourself and your parent(s) – (including stepparents), and
  • Your parents’ other children if (a) your parents will provide more than half of their support from July 1, 2017 through June 30, 2018, 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 will provide more than half of their support from July 1, 2017 through June 30, 2018.

Full Name / Age / Relationship / College
John Doe (example) / 18 / Brother / Central University
Self
  1. Student’s Income Information (all applicants) Dependent

□ I haveused the IRS Data Retrieval Toolin FAFSA on the Web to transfer2015IRS income tax return information on

my FAFSA.

□ I will provide theschool a copy of my signed 2015 Federal Income Tax Return.

□ I worked but am not required to file a 2015 Federal Income Tax Return.Complete the chart below and provide copies

ofyour W2 forms from 2015.

Note: Work study and co-op wages are subject to Federal tax filing guidelines.

Employer’s Name
List every employer even if the employer did not issue an IRS W2 form. / IRS W-2 Provided?
Yes or No / Annual Amount
Earned in 2015

□ I did not work and will not file a 2015 Federal Income Tax Return.

  1. Parent(s)’ Income Information

□ My parent(s) have used the IRS Data Retrieval Tool in FAFSA on the Web to transfer2015IRS income tax return

information on my FAFSA.

□ My parent(s) will provide the school a copy of their signed 2015Federal Income Tax Return.

□ My parent(s) worked but is not required to file a 2015 Federal Income Tax Return. Complete the chart below and

providecopies of your parents’ W2forms from 2015.

Employer’s Name
List every employer even if the employer did not
issue an IRS W2 form. / IRS W-2 Provided?
Yes or No / Annual Amount
Earned in 2015

□ My parent(s) did not work and will not file a 2015 Federal Income Tax Return.

  1. Sign This Worksheet

Each person signing this form certifies that all the information reported on it is complete and correct. The student and at least one parent must sign and date this form.

______

Student’s SignatureDate

______

Parent’s SignatureDate

Federal law restricts the way in which documents are submitted to the Financial Aid Office. Verification forms and taxtranscripts must be submitted by fax, by postal mail or in person.Attached documents to an email are no longer accepted to protect the privacy of student information.