FORT SCOTT COMMUNITY COLLEGE
2015-2016 Independent 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 2015-2016 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 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 student’s household. Include:

The student

The student’s spouse, if the student is married.

The student’s or spouse’s children if the student or spouse will provide more than half of their support
from July 1, 2015, through June 30, 2016, even if the children do not live with the student.

Other people if they now live with the student and the student or spouse provide more than half of their
support and will continue to provide more than half of their support through June 30, 2016.
NOTE: For any household member who will be enrolled at least half time (six credit hours) in a degree,
diploma, or certification program at an eligible postsecondary educational institution any time between July 1,
2015 and June 30, 2016, include the name of the college below.
Full Name
Age
Relationship
College Attending
John Doe (example)
25
Husband
Self
N/A
Enrolled at Least
Half Time (Y/N)
No
_____________________________
Student’s Last Name
_________________________ ____
Student’s First Name
M.I.
__________________
SSN or Student ID#
Receipt of SNAP Benefits:
Certify if a member of the student’s household, (refer to page 1), received benefits from the Supplemental
Nutrition Assistance Programs or SNAP (formerly known as the Food Stamp Program) sometime during 2013
or 2014. 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 2013 or 2014.
In 2013 or 2014, did the student or any member of the student’s household receive SNAP
benefits? Yes No
Child Support Paid:
It was indicated on the student’s FAFSA, that the student or spouse, who is a member of the student’s
household, paid child support in 2014. 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 2014 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 2014
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 2014 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 the IRS Data Retrieval Tool on their FAFSA.
The student is going to use the IRS Data Retrieval tool on their FAFSA.
The student has attached an IRS Tax Return Transcript to this form.
The student will submit an IRS Tax Return Transcript at a later date.
NOTE: If the student is married and the student and spouse filed separately, an IRS Tax Return Transcript
will need to be obtained 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 2014 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 2014.
The student was employed and had income earned from work in 2014.
NOTE: If the student was employed, list below the names of all the student’s employers, the amount earned
from each employer in 2014, and attach copies of all 2014 W-2 forms issued by the employer(s).
Employer Name
John’s Auto Body Shop (example)
2014 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 2015-2016.

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:
________________________________________________________________________
______________________________________________________
____________
___________________________________________
Student’s Last Name
Student’s First Name
M.I.
SSN or Student ID#
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 a
valid government-issued photo identification (ID), such as, but not limited to, a driver’s license, other stateissued 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 2015-2016.
____________________________________________________
(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 with
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:
A. A copy of the 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 Educational Purpose, which is provided below, 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
2015-2016.
________________________________________________
(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
________________________________________
Spouse’s Signature (Optional)
______________
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: ____________
Student’s FSCC ID# or SSN ________________________________
This form must be submitted to the Financial Aid Office by the following dates:
Fall 2015 – November 18th, 2015
Spring 2016 – April 20th, 2016
Summer 2016 – July 1st, 2016
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.
PRINT A TAX RETURN TRANSCRIPT
1. Go to www.irs.gov.
2. Under Tools, click on Get Transcript of Your Tax Records.
3. Click on Get Transcript Online and then create a login by selecting the Get Started button.
4. Type in the required information and then click on Send Email Confirmation Code.
5. Access your email, enter the confirmation code you received and then click on Continue.
6. Type in the required information and click on Continue.
7. Answer the verification questions and click on Continue. (If you are taken back to the home page, you
answered the questions incorrectly. You may try again from the beginning ).
8. Once you have correctly answered the verification questions, select the reason for your request as
Higher Education/Student Aid and then click on Go.
9. Under Return Transcript, select 2014. (Make sure your pop-up blocker is turned off).
10. Print your Tax Return Transcript and submit to the Financial Aid Office.
REQUEST TAX RETURN TRANSCRIPT TO BE MAILED
1. Go to www.irs.gov.
2. Under Tools, click on Get Transcript of Your Tax Records.
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 2014.
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.
 If you are unable to print or mail your Tax Return Transcript, you will need to speak with an IRS
representative at 1-800-829-1040.