2016-2017 Verification Worksheet
Independent
Your application was selected for review in a process called “Verification.” In this process, we must compare
information from your FAFSA application with information from your 2015 Federal tax data. The law states we must
ask you for this information before awarding Federal aid. If there are differences between your FAFSA application
information and your Federal tax data, we may need to make corrections electronically to your FAFSA.
Submit this information to the Office of Financial Aid at Marymount as soon as possible. Make sure the form is signed by
the student and spouse if married. This form needs to be filled out completely; if the answer is zero write “0”, do not leave
blank. Upon review of the documentation you submit, additional information may be required; notification of such will
be made as quickly as possible.
A. Student Information (Please Print)
Last name
First name
M.I.
Address (include apt. #)
City
Student’s Social Security Number *required
Date of birth
State
Zip Code
Phone number (include area code)
/Celphone #
Student Email
B. Family Information
List the people in your household, including:
• yourself and your spouse if you have one, and
• your children, if you will provide more than half of their support from July 1, 2016 through June 30, 2017, even if
they do not live with you and;
• 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, 2016 through June 30, 2017.
Write the names of all household members in the space(s) below. Also write in the name of the college that any household
member will be attending at least half time between July 1, 2016 and June 30, 2017. If you need more space, attach a separate
page.
Full Name
Age
Relationship
College
Self
Marymount University
Yes
No Did you or someone in your household as indicated above, receive food stamps in 2014 or 2015?
If Yes, please identify which family member here ___________________ and submit supporting documentation to verify
receipt such as a copy of the Food Stamp benefit card.
2
C. Student Income Verification (all applicants)
1. THE QUICKEST WAY TO HAVE INCOME VERIFIED IS TO USE THE IRS DATA RETRIEVAL .
The IRS Data Retrieval Tool will import your Federal Tax information into your FAFSA form. To use it:
 Go to www.FAFSA.ed.gov and log into the students FAFSA.
 Select “Make FAFSA Corrections”, and navigate to the STUDENT INFORMATION section of the FAFSA form.
 Follow the instructions to determine if the student is eligible to use the IRS Data Retrieval Tool to transfer 2015 IRS
income tax information. If ineligible, go to Step 2.
2. 2015 Federal Tax RETURN Transcripts must be submitted. You can request a 2015 Federal Tax Return Transcript (not an
Account Transcript) be sent to you in one of three ways:
 Online – Go to www.irs.gov and click on “Get Transcript of Your Tax Records”, “Get Transcript Online”
 Call – 1-800-908-9946 and follow the voice prompts.
 In person – Locate your local IRS office by going on to www.irs.gov and click on “Contact your local IRS
office” under “Learn about IRS”.
3. After reviewing steps 1 and 2 above, please, check one box below:
Check here if you used the IRS Data Retrieval tool on the FAFSA.
Check here if you are attaching a copy of your 2015 Federal Tax Return Transcript. Add the student’s id# on each page.
Check here if you will not file and ARE NOT required to file a 2015 U.S. Income Tax Return. (Then please, answer
question 4 and do not leave it blank.)
4. If you did not file and are not required to file a 2015 Federal income tax return, list below your employer(s) and any income
received in 2015. (YOU MUST PROVIDE THE W-2 OR OTHER EARNINGS STATEMENTS WITH THIS FORM).
Sources
2015 Income
$
$
5. Funds received for child support and other untaxed income.
Sources of Untaxed Income
2015 Amount
Sources of Untaxed Income
2015 Amount
a. Child Support
$
d.
$
b. Workman’s Compensation
$
e.
$
c. Untaxed Pensions
$
f.
$
3
D. Spouse Income Verification (if student is married)
Please refer to Section C, Student Income Verification, for information regarding use of the IRS Data Retrieval Tool.
Check here if your spouse used the IRS Data Retrieval tool on the FAFSA
Check here if you are attaching a copy of your spouse’s 2015 Federal Tax Return Transcript. Add the student’s id# on
each page.
Check here if your spouse will not file and IS NOT required to file a 2015 U.S. Income Tax Return. (Then please, answer
question 1 and do not leave it blank.)
1.
If your spouse did not file and is not required to file a 2015 Federal income tax return, list below your spouse’s employer(s)
and any income received in 2015. (You must provide the W-2 or other earnings statements with this form).
Sources
2015 Income
$
$
2.
Funds received for child support and other untaxed income.
Sources of Untaxed Income
2015 Amount
Sources of Untaxed Income
2015 Amount
a. Child Support
$
d.
$
b. Workman’s Compensation
$
e.
$
c. Untaxed Pensions
$
f.
$
E. Additional Financial Information and Untaxed Income
Use the tables below to report annual (not monthly) amounts. You will need your 2015 1040s Tax Return to complete
some of the following questions. If the amount is zero, write “0” or “N/A”. Do not leave any space blank.
STUDENT’S
2015 Additional Financial Information
a.
Education Credits (Hope and Lifetime Learning tax credits ) from
IRS Form 1040 – line 50 or 1040A – line 33.
b.
Child support paid you or your spouse you live with because of divorce or
separation or as a result of a legal requirement. You must supply a statement
from the payer of the child support indicating the annual amount of support
and the names of the children for which the funds are being paid.
c.
Taxable earnings from need-based employment programs, such
As Federal Work-Study and need-based employment portions of
Fellowships and assistantships.
d.
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 that were taxable income.
e.
Combat pay or special combat pay.
Only enter the amount that was taxable and included in your adjusted gross income.
f.
Earnings from work under a cooperative education program offered by a
College (do not include earnings from any Marymount work program).
$
$
$
$
$
$
4
g.
Payments to tax-deferred pension and savings plans (paid directly or withheld from
earnings), including, but not limited to, amounts reported on the W-2 forms in Boxes
12a through 12d. codes D, E, F, G, H and S. (Must submit W2.)
h.
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.
Child support received for all children in your household.
(Don’t include foster care or adoption payments).
$
$
i.
$
$
j.
Tax exempt interest income from IRS From 1040 - line 8b or 1040A Line 8b.
k.
Untaxed portions of IRA distributions from IRS Form 1040 – lines
15a minus 15b or 1040A – lines 11a minus 11b. Exclude rollovers. (Must submit 1099R)
l.
Untaxed portions of pensions from IRS Form 1040 lines 16a minus 16b or 1040A
lines 12a minus 12b. Exclude rollovers. If negative, enter “0”. (Must submit 1099R)
$
$
$
m. Housing, food and other living allowances paid to members of the military, clergy
and others (including cash payments and cash value of benefits).
n.
Veterans non-education benefits such as Disability Death Pension or Dependency
& Indemnity Compensation (DIC) and/or VA Educational Work-Study allowances.
o.
Other untaxed income not reported elsewhere on this form, such as workers’
compensation, disability, etc. Also include the untaxed portion of Health savings account from
Form 1040, line 25.
Don’t include student aid, earned income credit, child tax credit, welfare payments,
untaxed Social Security benefits. Workforce Investment Act educational benefits, combat pay,
(if you are a not a tax filer), benefits from flexible spending arrangements (e.g. cafeteria plans),
foreign income exclusion or credit for federal tax on special fuels.
p.
Money received, or paid on your behalf (e.g. bills), not reported elsewhere on this form.
$
$
$
F. Sign this Worksheet
I certify that the federal student financial assistance I may receive will only be used for educational purposes and to pay the cost of
attending the University for the 2016-17 academic year. Each person signing this form certifies that all the information reported
on it is complete and correct. If married, spouse’s signature is optional.
Student
Date
Spouse
Date
Submit this completed, signed verification worksheet and requested forms to:
Financial Aid Office
Marymount University
2807 N. Glebe Rd.
Arlington, VA 22207
FAX: 703-516-4771
Questions? Please call 703-284-1530 and we will be happy to assist you.