2017-2018 Independent Verification Worksheet

WHAT YOU MUST DO BEFORE FINANCIAL AID CAN BE AWARDED TO YOU

  1. Complete all sections and sign the worksheet.
  2. If you and/or spousedid not file or are not required to file a 2015 Federal tax return, you and your spouse must affirm that you are not required to file a 2015 Federal tax return and include a copy of all 2015 W-2 forms from all employers. Proceed to section A.
  3. Check the box that applies:

The student has used the IRS Data Retrieval Tool when completing the FAFSA on the Web

and did not make any changes to that information. No further documentation is required.

The student has not yet used the IRS Data Retrieval tool but will use the tool to transfer

2015 IRS income tax return information into the FAFSA on the web once the return has been

filed and processed.

The student is unable or chooses not to use the IRS Data Retrieval Tool and will instead

provide Faulkner University with the 2015 IRS Tax Return Transcript(s).

A 2015 Tax Return Transcript may be obtained through:

  • Get Transcript by MAIL – Go to under the Tools heading, click “Get a tax transcript.” click “Get Transcript by MAIL.” Make sure to request the “IRS Tax Return Transcript” and NOT the IRS Tax Account Transcript.”
  • Get Transcript ONLINE – Go to under the Tools heading, click “Get a tax Transcript.” click “Get Transcript ONLINE.” Make sure to request the “IRS Tax Return Transcript” and NOT the “IRS Tax Account Transcript.”
  • Automated Telephone Request – 1-800-908-9946
  • Paper Request Form –IRS Form 4506T-EZ or IRS Form 4506-T

In most cases, for electronic tax return filers, 2015 IRS income tax return information is available for the IRS DRT or the IRS Tax Return Transcript within 2-3 weeks after the 2015 electronic IRS income tax return has been accepted by the IRS. Generally, for filers of 2015 paper IRS income tax returns, the 2015 IRS income tax return information is available for the IRS DRT or the IRS Tax Return Transcript within 6-8 weeks after the 2015 paper IRS income tax return has been received by the IRS. Contact the financial aid office if more information is needed about using the IRS DRT or obtaining an IRS Tax Return Transcript.

If you and your spouse filed separate 2015 IRS income tax returns, the IRS DRT cannot be used and the 2015 IRS Tax Transcript(s) must be provided for each.

_____ Check here if a 2015 IRS Tax Return Transcript(s) is provided.

_____ Check here if a 2015 IRS Tax Return Transcript(s) will be provided later.

  1. Student Information (Please print)

Student ID#

Last NameFirst NameM.I. Social Security #

Address (include apt. #) City State Zip Code

Date of Birth E-mail Address Phone Number with area code

  1. Family Information

List the people in your household, include:

You and your spouse.

Your children, if you will provide more than half of their support from July 1, 2017 through June 30, 2018.

Other people if they now live with you and you provide more than half of their support and will continue to provide more than half of their support from July 1, 2017 through June 30, 2018.

Include in the space below information about any household member who is, or will be, enrolled at least half time in a degree, diploma or certificate program.

Number in College: Include in the space below information about any household member who is, or will be, enrolled at least half time in a degree, diploma, or certificate program at an eligible postsecondary educational institution any time between July 1, 2017 and Jun 30, 2018, and include the name of the college.

If more space is needed, provide a separate page with your name and ID number at the top.

Full Name / Age / Relationship / College Attending in
2017-2018 / Will be Enrolled at Least Half Time
(Yes or No)
Self

Note: We may require additional documentation if we have reason to believe that the information regarding the household members enrolled in eligible postsecondary educational institutions is inaccurate.

C. Tax Return Non filers

Complete this section if you, and, if married, your spouse, will not file and are not required to file a 2015 Federal income tax return with the IRS. If you were issued a W-2 you must attach it to this form.

Check the boxes that apply:

You were not employed and had no income earned from work in 2015.

You were employed in 2015 and have listed below the names of all employers, even if they did not

issue a W-2.

Your spouse was not employed and had no income earned from work in 2015.

Your spouse was employed in 2015 and has listed below the names of all employers, even if

they did not issue a W-2.

Employer’s Name / 2015 Amount Earned / IRS W-2 Provided? Yes or no

Provide documentation from the IRS or other relevant tax authority dated on or after October 1, 2016 that indicates a 2015 IRS income tax return was not filed with the IRS or other relevant tax authority.

_____ Check here if confirmation of nonfiling is provided.

_____ Check here if confirmation of nonfiling will be provided later.

D. Additional Income

Both tax filers and non-tax filers must list any untaxed income received in 2015. Be sure to enter zeros if no funds were received. Failure to complete this section will delay the processing of your verification.

Applicants with no taxable income, no earned income or no untaxed income as reported in Section D will be required to submit a Low Income Document form and letter explaining how living expenses were met.

Calendar Year 2015

/ Student / Spouse
Payments to tax-deferred pensions and savings plans (paid directly or withheld from earnings) including, but not limited to, amounts reported on W-2 Box 12a - 12d, codes D, E, F, G, H, & S. / $ / $
Untaxed portion of pensions. / $ / $
Untaxed portion of IRA Distributions / $ / $
Tax exempt interest income from 1040 line 8b or 1040A line 8b. / $ / $
Education credits from 1040 or 1040A. / $ / $
Housing Allowances / $ / $
VA-Non Education benefits / $ / $
Money paid on student’s behalf / $ / $

E. Child Support Received

List the actual amount of any child support received in 2015 for the children in your household. Do not include foster care, adoption or any amount that was court-ordered but not actually paid.

Name of Adult who Received Child Support / Name of Child for Whom Child Support was Received / Amount of Child Support Received in 2015

F. Sign this Worksheet

By signing this worksheet, I certify that all the information reported on this worksheet is complete and correct. Warning: If you purposely give false or misleading information on this worksheet, you may be fined, be sentenced to jail, or both.

______

Student’s SignatureDate

Return by mail, email or fax to:Faulkner University Financial Aid Office

5345 Atlanta Hwy, Montgomery, AL 36109

(334) 386-7195 or FAX: (334) 386-7201

E-MAIL - Revised 10/24/16