Bucks County Community College 2017 2018 Verification Worksheet Dependent Student V6 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 and your parents reported on your FAFSA. To verify that you provided correct information the Financial Aid Office 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 and at least one parent must complete and sign this worksheet, attach any required documents, and submit the form and other required documents to the Financial Aid Office within 21 days of receipt of this form. Your school may ask for additional information. If you have questions about verification, contact the Financial Aid Office as soon as possible so that your financial aid will not be delayed. A. Dependent Student s Information Last Name First Name M.I. SS# Street Address (include apt.#.) Student ID# City State Zip Code Student s Date of Birth Home Phone Number Alternate or Cell Phone Number E-Mail Address: B. Family and Household Information The legal parent s household can include: The student and the legal parent/stepparent(s). The legal parent/stepparent(s) other children, if they will receive more than half of their support from the legal parent/stepparent(s) from July 1, 2017, through June 30, 2018, or if the other children would be required to provide parental information if they were completing a FAFSA for 2017-2018. Include children who meet either of these standards even if a child does not live with the parents. Other dependents, if they now live with the legal parent/stepparent(s), and currently receive more than half of their support from the legal parent/stepparent(s), and will continue to do so from July 1, 2017 through June 30, 2018. Name of the college for any family member Enrolled Full name of family (excluding parents) who will be working Relationship Birthday at least High School members in the toward a degree or certificate and will be to Student mm/yy half time? Graduate by household. enrolled at least ½ time during 2017-18 September Start with student(s). academic year. 2017 1. Student Bucks County Community College Yes No 2. Yes No 3. Yes No 4. Yes No 5. Yes No Additional household members can be included on a separate sheet of paper. Total in Household Total in College
Student s Name: Student #: C. Dependent Student s Income Information To Be Verified Instructions: Complete this section if the student and parent(s), filed or will file a 2015 income tax return with the IRS. The best way to verify income is by using the IRS Data Retrieval Tool that is part of FAFSA on the Web. If you have not already used the tool, go to www.fafsa.gov, log in to your FAFSA record, select Make FAFSA Corrections, and navigate to the Financial Information section of the form. From there, follow the instructions to determine if you are eligible to use the IRS Data Retrieval Tool to transfer 2015 IRS income tax information into your FAFSA. It takes up to two weeks for IRS income information to be available for the IRS Data Retrieval Tool for electronic IRS tax return filers, and up to eight weeks for paper IRS tax return filers. If you need more information about when, or how to use the IRS Data Retrieval Tool see your financial aid administrator. You can request a tax transcript by visiting www.irs.gov or calling 1-800-908-9946. Student Tax Return Filers DID YOU FILE FEDERAL INCOME TAXES? YES Important Note: If the student filed, or will file, an amended 2015 IRS tax return, the student must contact the financial aid administrator before completing this section. Check only one box below: Check here, if you successfully imported 2015 tax data using the IRS Data Retrieval Tool. Check here if you are attaching a copy of your 2015 IRS Tax Transcript. Check here if you earned income, but did not file a 2015 Tax Return. If you did not file a 2015 Federal Tax Return, but earned income in 2015, you must still provide all W-2 forms or other earnings statements to the Financial Aid Office. To obtain a tax transcript, see the enclosed IRS TAX RETURN TRANSCRIPT REQUEST INSTRUCTIONS sheet. TAX RETURN NONFILERS ---DID YOU FILE FEDERAL INCOME TAXES? NO Complete this section if you, the student, will not file and is not required to file a 2015 income tax return with the IRS. Check the box that applies: I, the student was not employed and had no income earned from work in 2015. If your earned income is 10,150 or more, you must file a tax return. I, the student was employed in 2015 and has listed below the names of all the student s employers, the amount earned from each employer in 2015, and attached an IRS W-2 form(s) from each employer. List every employer even if they did not issue an IRS W-2 form. If more space is needed, attach a separate page with your name and Social Security Number at the top. Employer s Name 2015 Amount Earned IRS W-2 Attached? Suzy s Auto Body Shop (Example) 2,000.00 (example) Yes (example)
Student s Name: Student #: D. Parent(s) Income Information To Be Verified Parent Tax Filers Check only one box below: Check here, if you successfully imported 2015 tax data using the IRS Data Retrieval Tool. Note: you must still submit copies of all W2 forms or other earnings statements to the Financial Aid Office. Check here if you are attaching a copy of your 2015 IRS Tax Transcript and W2 Forms or other earning s statement. Check here if you earned income, but did not file a 2015 Tax Return. If you did not file a 2015 Federal Tax Return, but earned income in 2015, you must still provide all W2 forms or other earnings statements to the Financial Aid Office. Check here if you did not earn any wages or taxable income in 2015. Tax Return Nonfilers Complete this section if you, the parent(s), will not file and are not required to file a 2015 income tax return with the IRS. Check the box that applies: The parent(s) was not employed and had no income earned from work in 2015. The Parent was employed in 2015 and has listed below the names of all the parent s employers, the amount earned from each employer in 2015, and attached an IRS W-2 form(s) from each employer. List every employer even if they did not issue an IRS W-2 form. If more space is needed, attach a separate page with your name and Social Security Number at the top. Employer s Name 2015 Amount Earned IRS W-2 Attached? Suzy s Auto Body Shop (Example) 2,000.00 (example) Yes (example) E. Dependent Student s and Parent(s) Other Information to Be Verified RECEIPT OF BENEFITS Have you or a member of your household (spouse, children or other individuals that live in the household and receive more than half of the applicant s support) received any benefits from any source listed below in 2015? Check all boxes that apply: NO Check here if neither you nor a member of your household (spouse, children or other individuals that live in the household and receive more than half of the applicant s support) received any benefits listed above in calendar year 2015 and/or 2016. YES SNAP (Supplemental Nutrition Assistance Program) WIC (The special Supplemental Nutrition Program for Women, Infants, and Children) TANF (Temporary Assistance for Needy Families) I AM SUBMITTING documentation from the agency that issued the benefits in 2015 and/or 2016.
CHILD SUPPORT RECEIVED DO NOT include foster care or adoption payments in this section. During 2015 was child support RECEIVED by any member of the household listed on the form? NO YES *If yes, complete the chart and provide A statement from the individual receiving the child support showing the amount provided; OR Copies of the child support checks or money order receipts. Name of Person Who Receives Child Support Name of Child for Whom Support Was Received Amount of Child Support Received in 2015 Marty Jones (example) Terry Jones (example) 6,000.00 (example) CHILD SUPPORT PAID DO NOT include foster care or adoption payments in this section. During 2015 was child support paid by any member of the household listed on the form? NO YES If yes, complete the chart and provide a copy of acceptable documentation of the payment of child support. Name of Person Who Paid Child Support Name of Person to Whom Child Support Was Paid Name of Child for Whom Support Was Paid Amount of Child Support Paid in 2015 Marty Jones (example) Chris Smith (example) Terry Jones (example) 6,000.00 (example) I have provided copies of acceptable documentation of the payment of child support F. Untaxed Income to be Verified For the Parent s column, enter the amount for the student s parent(s). For the Students column, enter the amount for the student. These questions must be completed. If they do not pertain to you enter a 0 Parents 2015 Additional Financial Information (Q94) a.) Education credits (Hope and lifetime Learning tax credits) from IRS Form 1040 line 49 or 1040A- line 31. b.) Child support paid because of divorce or separation or as a result of a legal requirement. Don t include support for children in your (or your parents ) household, as reported in question 95 (or question 73 for your parents). c.) Taxable earnings from need-based employment programs, such as Federal Work- Student and need-based employment portions of fellowships and assistantships. d.) Taxable student grant and Scholarship aid reported to the IRS in your adjusted gross income. Includes AmeriCorps benefits (awards, living allowances and interest accrual payments), as well as grant and scholarship portions of fellowships and assistantships. e.) Combat pay or special combat pay. Only enter the amount that was taxable and included in the adjusted gross income. Don t include untaxed combat pay. f.) Earning from work under a cooperative education program offered at the college. TOTALS Student s (Q45)
Student s Name: SSN/Student ID: G. Untaxed Income to be Verified-Continued For the Parent s column, enter the amount for the student s parent(s). For the Students column, enter the amount for the student. These questions must be completed. If they do not pertain to you enter a 0 Parents Student s 2015 Untaxed Income (Q94) (Q45) a.) Payments to tax-deferred pension and savings plan (paid directly or withheld from earnings), including, but not limited to, amounts reports on the W-2 forms in Boxes 12a through 12d, codes D, E, F, G, H, and S. b.) IRA deductions and payments to self-employed SEP, SIMPLE, Keogh and other qualified plans from IRS Form 1040-line 28 + line 32 or 1040A-line 17. c.) Child support received for all children. Don t include foster care or adoption payments. d.) Tax exempt interest income from IRS Form 1040-line 8b or 1040A-line 8b. e.) Untaxed portions of IRA distributions from IRS Form 1040-lines (15a minus 15b) or 1040A-lines (11a minus 11b). Exclude rollovers. If negative, enter a zero here. f.) Untaxed portions of pensions form IRS Form 1040-lines (16a minus 16b) or 1040A-lines (12a minus 12b). Exclude rollovers. If negative enter a zero here. g.) Housing, food and other living allowances paid to members of the military, clergy and others (including cash payments and cash value of benefits). Don t include the value of onbase military housing or the value of basic military allowance for housing. h.) Veterans non education benefits such as Disability, Death Pension, or Dependency & Indemnity Compensation (DIC) and/or VA Educational Work-Study allowances. i.) Other untaxed income not reported in items 45a through 45h for students and items 94a through 94h for parents, such as worker s compensation, disability, etc. Also include the untaxed portion of health savings accounts from IRS Form 1040 line 25. Don t include extended foster care benefits, student aid, earned income credit, additional child tax credit, welfare payments, untaxed Social Security benefits, Supplemental Security Income, Workforce Investment Act educational benefits, on-base military housing or a military housing allowance, combat pay, benefits from flexible spending arrangements (e.g. cafeteria plans), foreign income exclusion or credit for federal tax on special fuels. j.) Money received, or paid on your behalf (e.g., bills), not reported elsewhere on this form. TOTALS H. Certification and Signatures Each person signing this worksheet certifies that all of the information reported on it is complete and correct. The student and one parent must sign and date. WARNING: If you purposely give false or misleading information on this worksheet, you may be fined, be sentenced to jail, or both. Student s Signature Parent s Signature Date Date Submit this worksheet to: Bucks County Community College, Financial Aid Office, 275 Swamp Road, Newtown, PA 18940 Fax #: ( 215) 504-8522 Email: finaid@bucks.edu. Phone #: 215 968-8200. Note: Any form with incomplete or blank information and/or not having complete signatures will be returned, and delay processing. You should make a copy of this worksheet for your records. Bucks County Community College complies with applicable state and federal civil rights laws and does not discriminate in its educational programs, activities or employment practices.