FORT SCOTT COMMUNITY COLLEGE
2016-2017 Dependent Verification Form (V5-Aggregate)
This form can only be hand-delivered or mailed to the Financial Aid Office.
It cannot be faxed or e-mailed.
Fort Scott Community College, Attn: Financial Aid Office, 2108 S. Horton, Fort Scott KS, 66701
Your 2016-2017 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 must ask you to confirm the
information you reported on your FAFSA. To verify that you provided correct information, we will compare
your FAFSA with the information on this institutional verification document and with any other required
documents. If there are differences, your FAFSA information may need to be corrected. You and a parent
whose information was reported on the FAFSA must complete and sign this institutional verification document,
attach any required documents, and submit the form and other required documents to us. We may ask for
additional information. If you have questions about verification, contact us as soon as possible so that your
financial aid will not be delayed.
_____________________________
Student’s Last Name
_________________________ ____
Student’s First Name
M.I.
__________________
SSN or Student ID#
_____________________________________________________________________________________________________________________________________________________________
___________________________________________
Student’s Street Address
Student’s DOB
City
State
Zip
Household Members and Number in College:
List below the people in the parent(s)’ household. EVEN IF THEY ARE NOT ATTENDING COLLEGE.
Include:

The student

The parent(s), including a stepparent, even if the student does not live with the parent(s).

The parent(s)’ other children if the parent(s) will provide more than half of their support from July 1,
2016, through June 30, 2017, or if the other children would be required to provide parental information
if they were completing a FAFSA for 2016-2017. Include children who meet either of these standards
even if the children do not live with the parent(s).

Other people if they now live with the parent(s) and the student’s parent(s) provide more than half of
their support and will continue to provide more than half of their support through June 30, 2017.
Full Name
Age
Relationship
John Doe (example)
18
Brother
Self

College Attending
(Or leave blank)
FSCC
Enrolled at Least
Half Time (Y/N)
Yes
For any household member you listed above, also indicate who will be enrolled at least half-time at an
eligible postsecondary educational institution any time between July 1, 2016 and June 30, 2017
_____________________________
Student’s Last Name
_________________________ ____
Student’s First Name
M.I.
__________________
SSN or Student ID#
Receipt of SNAP Benefits:
Certify if a member of the parents’ household, (refer to page 1), received benefits from the Supplemental
Nutrition Assistance Programs or SNAP (formerly known as the Food Stamp Program) sometime during 2014
or 2015. SNAP may be known by another name in some states. For assistance in determining the name used in
a state, please call 1-800-433-3243.
NOTE: If we have reason to believe that the information regarding the receipt of SNAP benefits is inaccurate,
we may require documentation from the agency that issued the SNAP benefits in 2014 or 2015.
In 2014 or 2015, did you or any member of your parents’ household receive SNAP
benefits? Yes No
Child Support Paid:
It may have been indicated on the student’s FAFSA, that the student or one of the parents included in the
household, paid child support in 2015. List below the names of the persons who paid the child support, the
names of the persons to whom the child support was paid, the names of the children for whom the child support
was paid, and the total annual amount of child support that was paid in 2015 for each child. If no child support
was paid, please write N/A on the table below.
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
NOTE: If we have reason to believe that the information regarding child support paid is not accurate, we may
require additional documentation; such as:

A copy of the separation agreement or divorce decree that shows the amount of child support to
be provided

A statement from the individual receiving the child support certifying the amount of child
support received

Copies of the child support payment checks or money order receipts
_____________________________
Student’s Last Name
_________________________ ____
Student’s First Name
M.I.
__________________
SSN or Student ID#
Student’s Tax Information:
Did the student file taxes for the 2015 year?
Yes
No
If no, skip to the TAX NON-FILER section below. (Do not fill out the tax filer section).
If yes, please continue to the TAX FILER section. (Do not fill out the tax non-filer section).
TAX FILER:
In order to verify the student’s tax information, one of the following steps must be completed:
(Please refer to the detailed directions at the end of this form).
The student has used or is going to use the IRS Data Retrieval Tool on their FAFSA.
The student has submitted or is going to submit an IRS Tax Return Transcript to the Financial
Aid Office.
NOTE: For electronic filers, the IRS Data Retrieval Tool and the IRS Tax Return Transcript should be
available 2-3 weeks after their 2015 IRS Income Tax Return has been accepted by the IRS. For paper filers,
they are available after 8-11 weeks.
TAX NON-FILER:
The student was not employed and had no income earned from work in 2015.
The student was employed and had income earned from work in 2015.
NOTE: If the student was employed, list below the names of all the student’s employers, the amount earned
from each employer in 2015, and attach copies of all 2015 W-2 forms issued by the employer(s).
Employer Name
John’s Auto Body Shop (example)
2015 Amount Earned
$2,000
W-2 Form Attached (Y/N)
Yes
_____________________________
Student’s Last Name
_________________________ ____
Student’s First Name
M.I.
__________________
SSN or Student ID#
Parent(s)’ Tax Information:
Did the student’s parent(s) file taxes for the 2015 year?
Yes
No
If no, skip to the TAX NON-FILER section below. (Do not fill out the tax filer section).
If yes, please continue to the TAX FILER section. (Do not fill out the tax non-filer section).
TAX FILER:
In order to verify the parent(s)’ tax information, one of the following steps must be completed:
(Please refer to the detailed directions at the end of this form).
The student has used or is going to use the IRS Data Retrieval Tool on their FAFSA for their
parent(s)’ tax information.
The student has submitted or is going to submit their parent(s)’ IRS Tax Return Transcript(s) to
the Financial Aid Office.
NOTE: If the student’s parent(s) filed separately, they will need to obtain tax return transcripts for both
individuals. For electronic filers, the IRS Data Retrieval Tool and the IRS Tax Return Transcript should be
available 2-3 weeks after their 2015 IRS Income Tax Return has been accepted by the IRS. For paper filers,
they are available after 8-11 weeks.
TAX NON-FILER:
The student’s parent(s) were not employed and had no income earned from work in 2015.
The student’s parent(s) were employed and had income earned from work in 2015.
NOTE: If the student’s parent(s) were employed, list below the names of all the parent(s)’ employers, the
amount earned from each employer in 2015, and attach copies of all 2015 W-2 forms issued by the employer(s).
Employer Name
John’s Auto Body Shop (example)
2015 Amount Earned
$2,000
W-2 Form Attached (Y/N)
Yes
_________________________
Student’s Last Name
______________________
Student’s First Name
_____
M.I.
____________________
SSN or Student ID#
High School Completion Status:
Provide ONE of the following documents that indicate the student’s high school completion status when the
student will begin college in 2016-2017.

The student’s final official high school transcript that shows the date when the diploma was awarded.
(This item may be faxed directly from the student’s high school to 620-768-2938).

A copy of the student’s General Educational Development (GED) certificate or GED transcript.

If State law requires a homeschooled student to obtain a secondary school completion credential for
homeschool (other than a high school diploma or its recognized equivalent), a copy of that credential.

If State law does not require homeschooled student to obtain a secondary school completion credential
for homeschool (other than a high school diploma or its recognized equivalent), a transcript or the
equivalent, signed by the student’s parent or guardian, that lists the secondary school courses the student
completed and documents the successful completion of a secondary school education in a homeschool
setting.
If you have already submitted one of the above mentioned items, please check here:
If you are going to submit one of the above mentioned items, please check here:
If one of the above mentioned items is attached to this form, please check here:
Identity and Statement of Educational Purpose (To be signed at the
FSCC Financial Aid Office*):
The student must appear in person at Fort Scott Community College to verify his or her identity by presenting
an unexpired valid government-issued photo identification (ID), such as, but not limited to, a driver’s license,
other state-issued ID, or passport. The institution will maintain a copy of the student’s photo ID that is
annotated by the institution with the date it was received and reviewed and the name of the official at the
institution authorized to collect the student’s ID.
In addition, the student must sign, in the presence of the institutional official, the Statement of Educational
Purpose provided below.
Statement of Educational Purpose
I certify that I _____________________________________ am the individual signing this Statement
(Print Student’s Name)
of Educational Purpose and that the Federal student financial assistance I may receive will only be used
for educational purposes and to pay the cost of attending Fort Scott Community College for 2016-2017.
____________________________________________________
(Student’s Signature)
______________
(Date)
_________________________________
(Student’s ID Number)
FOR FINANCIAL AID OFFICE USE ONLY:
WITNESS ___________________________________
DATE __________________
*If you are unable to appear in person at the FSCC
Financial Aid Office, please see the following page.
_________________________________________________________________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________________
______________________________
____________________________________________________________________________________________________________
Student’s Last Name
Student’s First Name
M.I.
SSN or Student ID#
Identity and Statement of Educational Purpose (To be signed in the
Presence of a Notary):
If the student is unable to appear in person at Fort Scott Community College to verify his or her identity, the
student must provide to the institution:
A. A copy of the unexpired valid government-issued photo identification (ID) that is acknowledged
in the notary statement below or that is presented to a notary, such as, but not limited to, a
driver’s license, other state-issued ID, or passport; and
B. The original Statement of Education Purpose provided below, which must be notarized. If the
notary statement appears on a separate page than the Statement of Educational Purpose, there
must be a clear indication that the Statement of Educational Purpose was the document
notarized.
Statement of Educational Purpose
I certify that I ____________________________________ am the individual signing this
(Print Student’s Name)
Statement of Educational Purpose and that the Federal student financial assistance I may receive will
only be used for educational purposes and to pay the cost of attending Fort Scott Community College for
2016-2017.
________________________________________________
(Student’s Signature)
______________
(Date)
______________________________
(Student’s ID Number)
Notary’s Certificate of Acknowledgement
Notary’s certification may vary by State
State of ___________________________________________________________________________________
City/County of _____________________________________________________________________________
On _________________, before me, ____________________________________________________________
(Date)
(Notary’s name)
personally appeared, _________________________________________________, and proved to me on basis
(Printed name of signer)
of satisfactory evidence of identification __________________________________________ to be the above(Type of government-issued photo ID provided)
named person who signed the foregoing instrument.
WITNESS my hand and official seal
(seal)
__________________________________________
(Notary Signature)
My commission expires on ___________________.
(Date)
Certification and Signatures:
Each person signing below certifies that all of the
Information reported is complete and correct.
________________________________________
Student’s Signature
______________
Date
________________________________________
Parent’s Signature
______________
Date
WARNING: If you purposely give
false or misleading information,
you may be fined, be sentenced to
jail, or both.
Certification
READ, SIGN, AND DATE
If you are the student, by signing this application you certify that you (1) will use federal and/or state student financial
aid only to pay the cost of attending an institution of higher education, (2) are not in default on a federal student loan or
have made satisfactory arrangements to repay it, (3) do not owe money back on a federal student grant or have made
satisfactory arrangements to repay it, (4) will notify your college if you default on a federal student loan, and (5) will not
receive a Federal Pell Grant from more than one college for the same period of time.
If you are the parent or the student, by signing this application you agree, if asked, to provide information that will verify
the accuracy of your completed form. This information may include U.S. or state income tax forms that you filed or
required to file. Also, you certify that you understand that the Secretary of Education has the authority to verify
information reported on this application with the Internal Revenue Service and other federal agencies. If you sign any
document related to the federal student aid programs electronically using a Personal Identification Number (PIN), you
certify that you are the person identified by the PIN and have not disclosed that PIN to anyone else. If you purposely give
false or misleading information, you may be fined $20,000, sent to prison, or both.
Everyone whose information is given on this form should sign below. The student (and at least one parent, if parent
information is given) MUST sign below.
Student________________________________________________ Date: ____________
Parent_________________________________________________Date:_____________
Student’s FSCC ID# or SSN _________________________________
This form must be submitted to the Financial Aid Office by the following dates:
Fall 2016 – November 18th, 2016
Spring 2017 – April 21st, 2017
th
Summer 2017 – June 5 , 2017 (4 week session) and July 3rd, 2017 (8 week session)
Failure to meet these deadlines may result in no aid awarded for that semester
HOW TO USE THE DATA RETRIEVAL TOOL ON YOUR FAFSA
1. Log into your FAFSA at www.fafsa.ed.gov.
2. When you come to the tab for Financial Information, select Already Completed your IRS
Income Tax Return.
3. On the next question, select the appropriate tax filing status. Ex: Single, Married-Filed Jointly.
4. You may be able to use the Data Retrieval Tool if you answer No to all the questions asked – Did
you file an amended tax return? Did you file a foreign tax return? Did you file in the last three
weeks?
5. If you answered no to the above questions, click on Link to IRS.
6. Select OK when it asks if you want to leave FAFSA on the Web.
7. On the IRS site, you will have to provide your filing status, name and address exactly as it was
listed on your tax return. (If you are having trouble matching your address, go to www.usps.com, use the
8.
Look Up a Zip Code option, type your street address, city, state and zip and hit FIND. Use the “standard” address
that is displayed).
Click on Submit and it will show you the information that will be transferred. (If it did not work
than the address you provided is probably incorrect according to the IRS’ records. You may try again but you will be
locked out after three failed attempts).
9. Check the Transfer my Tax Information into the FAFSA box and then click the Transfer Now
button.
10. Once the information has been transferred, do not make any changes!
11. Enter the information for your wages and click Next.
12. Again, any information transferred by the IRS should not be changed. If selected for
verification, this will delay your financial aid being processed.
13. Finish filling out your FAFSA, sign with your PIN, and submit.
 You may not be eligible to use the IRS Data Retrieval if:
 You filed your tax return within the past two weeks
 You filed an amended tax return
 Your filing status is “Married Filing Separately”
 You filing status is “Head of Household” and you actually are married (but not separated or
divorced).
 If you are unable to transfer your tax information using the Data Retrieval Tool, you will need to use
copies of your tax returns to fill out the FAFSA. If you need the Data Retrieval Tool completed for
verification purposes, you will need to request a tax return transcript.
 If you are still having trouble with using the Data Retrieval, call the FAFSA hotline at 1-800-433-3243.
REQUEST TAX RETURN TRANSCRIPT TO BE MAILED
1. Go to www.irs.gov.
2. Under Tools, click on Get a Tax Transcript.
3. Click on Get Transcript by Mail, and then Ok.
4.
Type in the required information and then click on Continue. (You must enter the information listed under
the primary taxpayer).
5. Under Type of Transcript, select Return Transcript.
6. Under Tax Year, select the correct tax year. If you are using this transcript for your 2016-2017
FAFSA, you will need to select the 2015 tax year.
7. Click on Continue.
8. A Tax Return Transcript will be mailed to the address you provided in approximately 5-10 days.
Submit to the Financial Aid Office as soon as possible.