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2016-17 V1 PARENT VERIFICATION WORKSHEET
STUDENT NAME: LAST______________________________ FIRST___________________________ MI_____ ID _______________
Your student’s FAFSA was selected for review in a process called "Verification". In this process, our office will be comparing information from your student’s FAFSA
with signed copies of your and your student’s 2015 Federal tax transcripts, W-2 forms or other financial documents. Federal Regulations state we have the right to
ask you for this information before awarding federal aid. If there are differences between your FAFSA information and your financial documents, we may need to
make corrections electronically.
Parent Income Information – Accurate amounts must be reported
1. Did parent(s) file a 2015 Federal Income Tax Return? (Include step-parent if remarried)
 Yes 
submit a signed copy of parent(s) 2015 IRS Tax Return Transcript.
To submit this information, you can:
 Have the student go back into their FAFSA at www.fafsa.gov and use the IRS Data Retrieval link.
Note: You must also complete the student and parent earnings from work questions on the FAFSA.
OR
 Request a Tax Transcript from the IRS online at www.irs.gov and click on the “Order a Transcript” link or
by calling 1-800-908-9946. Request the "Return transcript" NOT the "Account Transcript".
Note: If your parent(s) filed a tax return from Puerto Rico or a foreign country, they must submit a signed
copy of their tax return. If they did not keep a copy of their tax return, they can request a copy from their
tax preparer or from the IRS by calling 1-800-829-1040.
Check only one box below. (Skip income from work, go to question 2)
 Parent is going to use the IRS Data Retrieval link in their FAFSA.
 Parent(s)’ signed tax transcript will be submitted to the school by _______________(date).
 No 
complete this section if parent(s) will not file and are not required to file a 2015 income tax return with the IRS.
Note: If income is greater than $10,300 and you are single or $20,600 and you are married, parent(s) are required to file and must submit a
signed copy of their tax return transcript. For more information on tax filing requirements visit www.irs.gov/publications/p17.
What was their total income earned from work for 2015? (Include odd jobs, etc. If no income from work, enter zero.)
Total Amount $_____________ earned by Parent 1
Employer/Source of Income (i.e. odd jobs, house cleaning)
Complete table below. Do NOT leave blank.
Amount earned
W2 or 1099 received?
 Yes
 No
 Yes
 No
 Yes
 No
You MUST submit a copy of ALL W2s and 1099s received.
Total Amount $_____________ earned by Parent 2
Employer/Source of Income (i.e. odd jobs, house cleaning)
Complete table below. Do NOT leave blank.
Amount earned
W2 or 1099 received?
 Yes
 No
 Yes
 No
 Yes
 No
You MUST submit a copy of ALL W2s and 1099s received.
COMPLETE AND SIGN BACK OF FORM →
2. Savings and Investments (Assets)
Use amounts as of the date you completed the FAFSA to answer the following questions.
As of the date you completed the FAFSA:
$ __________ What was the total balance of cash, savings, and checking accounts?
$ __________ What was the Net Worth (Value minus debt) of Investments?
Exclude primary residence. (Click here for more detailed information.)
Exclude IRAs, 401Ks, & 403Bs
$ __________ What was the Net Worth (value minus debt) of Business and/or Investment
Farms?
For help with these questions visit:
http://studentaid.ed.gov/fafsa/filling-out#parent-info
3. 2015 Additional Parent Financial Information – Do not include support for children in your household
$__________ Total Child support parent(s) paid because of divorce, or separation, or as a result of a legal requirement
If none, enter zero. DO NOT LEAVE BLANKS.
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
4. 2015 Parent(s)’ Untaxed Income
$__________
Child Support parent received for all children – Don’t include foster care or adoption payments
$__________
Payments to tax-deferred pension and savings plans (paid directly or withheld from earnings)
including amounts reported on the W-2 Form in Boxes 12a – 12d, codes D, E, F, G, H, and S
5. Did someone in the parent(s)’ household receive benefits from the Supplemental Nutrition Assistance Program or SNAP (also
known as food stamps or Cal Fresh) any time during the 2014 or 2015 calendar years?  Yes
 No
BY SIGNING THIS FORM, I/WE CERTIFY THAT ALL THE INFORMATION REPORTED TO QUALIFY FOR STUDENT FINANCIAL AID IS
COMPLETE AND CORRECT.
Warning: If you purposely give false or misleading information, you may be fined, sentenced to prison, or both.
Parent Name (please print) _________________________________________________________
Parent Signature (Required) _______________________________________________________ Date _______________________________