2016-17 Verification Worksheet
Independent Student – V1
Your 2016-2017 Free Application for Student Aid (FAFSA) was selected for a review in a process called verification. The
law says that before awarding Federal Student Aid, we may ask you to confirm the information you reported on your
FAFSA. To verify that you provided correct information the financial aid administrator at your school will compare your
FAFSA with the information on this worksheet and with any required documents. If there are differences, your FAFSA
information may need to be corrected. You must complete and sign this worksheet, attach any required documents, and
submit the form to the financial aid administrator at your school. Your school may ask for additional information. If you
have questions about verification, contact your financial aid administrator as soon as possible so that your financial aid
will not be delayed.
A. Student Information
________________________________________________
__________________________
Last Name
Social Security Number
First Name
M. I.
________________________________________________
__________________________
Address (include apt. no.)
Date of Birth
________________________________________________
__________________________
City
Phone Number (include area code)
State
Zip Code
B. Family Information
List the people in your household. Include:
 Yourself.
 Your spouse, if you are married.
 Your children, if any, if you will provide more than half of their support from July 1, 2016, through June 30, 2017,
or if the child would be required to provide your information if they were completing a FAFSA for 2016-2017.
Include children who meet either of these standards, even if they do not live with you.
 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 through June 30, 2017.
Include the name of the college for any household member who will be enrolled, at least half time in a degree, diploma, or
certificate program at a postsecondary educations institution any time between July 1, 2016, and June 30, 2017. If more
space is needed, attach a separate page with the student’s name and Social Security Number at the top.
Full Name
Missy Jones (example)
Age
18
Relationship
College
Wife
Self
Central University
Will be Enrolled
at Least Half
Time
Yes
TAX RETURN FILERS – Important Note: If you (or your spouse, if married) filed, or will file, an amended 2015 IRS tax
return, or granted a filing extension by the IRS, the student must contact the financial aid administrator before
completing section C.
Instructions: Complete these sections if you, the student (or your spouse if married), filed or will file a 2015 income tax
return with the IRS. The best way to verify income is by using the IRS Date Retrieval Tool that is part of FAFSA on the
Web. If you have not already used the tool, go to 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 to transfer 2015 IRS income tax information into the student’s
FAFSA. It takes up to 2-3 weeks for the IRS income information to be available for the IRS Data Retrieval Tool for
electronic IRS tax return filers, and up to 8-11 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.
C. Student’s Tax Forms and Income Information (all applicants)
1. Check only one box below. Tax transcripts include the 2015 IRS transcript filing Form 1040, 1040A, and 1040EZ.




Check here if you are updating your 16-17 FAFSA by using the IRS Data Retrieval Tool.
Check here if you are attaching a copy of your (or your spouse if married) tax transcript.
Check here if a tax transcript will be submitted to the school by ______________ (date).
Check here if you (or your spouse, if married) were not employed and had no income earned from work in 2015.
2. If you (or your spouse, if married) 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 form or other earnings statements with this form).
Employer’s Name
Suzy’s Auto Body Shop (example)
2015 Amount Earned
$2,000.00 (example)
IRS W-2 Attached?
Yes (example)
D. Child Support Paid
If you (or your spouse, if married) paid child support in 2015 complete the following information.
Name of Person Who Paid
Child Support
Mary Jones
Name of Person to Whom
Child Support was Paid
Chris Smith (example)
Name & Age of Child for
Whom Support was Paid
Terry Jones – 10 yrs. old
Annual Amount of Child
Support Paid in 2015
$6,000.00
Note: If we have reason to believe that the information regarding the child support paid is not accurate, we may
require additional documentation.
E. Supplemental Nutrition Assistance Program or SNAP (formerly known as food stamps)
Did you or someone in your household receive SNAP in 2014 or 2015?
___ Yes
___ No
Note: If we have reason to believe that the information regarding the receipt of SNAP benefits is inaccurate, we may
require documentation for the agency that issued the SNAP benefits in 2014 or 2015.
F. Sign this Worksheet
Each person signing this form certifies that all the information
reported on it 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 Signature
Date
___________________________________________
Spouse’s Signature
Date