Verification Worksheet
2010-2011
Dependent
I
Your application has been selected for review in a process called “Verification”. In this process, the Office of Financial Assistance at Meredith
College must compare information from your Free Application for Federal Student Aid (FAFSA) with SIGNED copies of your 2009 Federal
income tax forms, W-2 forms and/or other financial documents. The law gives us the authority to ask for this information before awarding
Federal aid. If there are differences between your application information and your financial documents, the Office of Financial Assistance
will make the appropriate changes to your application.
What you need to do:
1.
2.
3.
Collect and photocopy your (and your spouse’s) SIGNED
2009 Federal income tax forms, supporting schedules/forms.
Complete and SIGN this worksheet.
Take/send the completed worksheet and SIGNED copies of
tax forms and other documents to the Office of Financial
Assistance.
Submit your verification documents as soon as possible so that
your financial aid will not be delayed. The Office of Financial
Assistance will compare the submitted documents with your
FAFSA information. If there are any discrepancies, our office
may request further clarification. A financial aid counselor can
help you if you have questions about completing this worksheet.
A. Student Information
________________________________________________________
Last Name
First Name
M.I.
_______________________________________________________
Social Security Number
________________________________________________________
Address (include apartment number)
_______________________________________________________
Date of Birth
________________________________________________________
City
State
Zip Code
_______________________________________________________
Phone Number (include area code)
B. Family Information
List the people in the grid below that you (and your spouse) will
support between July 1, 2010 and June 30, 2011. Include:

Yourself

Your spouse

Your dependent children (IF you will provide more than half
their support from July 1, 2010 through June 30, 2011, or the
children would be required to provide parental information
when applying for Federal Student Aid).
Full Name
Age
Relationship
Self
Include other people as part of your family only if:

They lived with you and received more than half their
support from you at the time you completed your FAFSA
AND

They will continue to receive more than half their support
from you from July 1, 2010 through June 30, 2011.
Name of school, college, or employer
Meredith College
Of those listed above, write in the name of the college for any family member who will be enrolled at least half-time in a degree or certificate
program between July 1, 2010 and June 30, 2011. Note: if you need more space, attach a separate page.
C. Taxes
STUDENT/SPOUSE TAX INFORMATION
Please check one of the following:


I/we have attached or will send my/our SIGNED 2009 Federal income tax return(s) and W-2 forms.
I/we am/are not required to and will not file a 2009 Federal income tax return 1040/1040A/1040EZ/1040x/Telefile.
Over
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Non-Filing Statement of Earnings:
If you or your spouse did not file and are not required to file a 2009 Federal income tax return, please list below your and your
spouse’s employer(s) and any income received in 2009 (use W-2 form or other earnings statements if available).
Employer/Sources
2009 amount
Student
$
Spouse
$
$
$
D. 2009 Untaxed Income Information
Please use calendar 2009 amounts (Jan 1 to Dec 31).
If no money was received in the category, please place a zero in the column.
Student
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.
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. Do not include foster care or adoption payments.
Tax exempt interest income from IRS form 1040-line 8b, or 1040A-line 8b.
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.
Untaxed portions of pensions from IRS form 1040-lines (16a minus 16b), or 1040A-lines (12a
minus 12b). Exclude rollovers. If negative, enter a zero here.
Housing, food and other living allowances paid to members of the clergy and others (including
cash payments and cash value of benefits.)
Veterans noneducation benefits such as Disability, Death Pension, or Dependency & Indemnity
Compensation (DIC) and/or VA Educational Work-Study allowances.
Other untaxed income not reported, such as workers’ compensation, disability, etc. Don’t
include student aid, earned income credit, additional child tax credit, welfare payments, untaxed
Social Security benefits, Supplemental Security Income, Workforce Investment Act educational
benefits, combat pay, benefits from flexible spending arrangements (e.g., cafeteria plans), foreign
income exclusion, veterans educational benefits, or credit for federal tax on special fuels.
Money received, or paid on your behalf (e.g. bills), not reported elsewhere on this form.
Spouse
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
E. Sign this Worksheet
By signing below, I /we certify that all of the information reported on this verification worksheet is complete and correct.
WARNING: If you purposely give false or misleading information on this worksheet, you may be fined and/or sentenced to jail.
___________________________________________________
Student Signature
Date
___________________________________________________
Spouse Signature
Date
Mail or return this form and accompanying documentation to:
Meredith College, Attn: Office of Financial Assistance
3800 Hillsborough St. Raleigh, NC 27607
Fax: (919) 760-2373
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