Non-Filer Statement
2015-2016
Student Name _______________________________________ KSU ID# _________________________
Relationship to student:
Student
Spouse
Parent
The following documents must be provided with this form:
Verification of nonfiling (Request using IRS Form 4506-T) – This document is proof from the IRS that you
did not file a tax return for the year. Form can be ordered at: http://www.irs.gov/pub/irs-pdf/f4506t.pdf
or by calling 1-800-908-9946
W-2 (Wage and Tax Statement) – if any wages were earned during 2014 your employer must provide this
document to you.
I did not and will not file a Federal Tax Return for the year 2014.
_____ I did not earn income from work in 2014.
(initial)
OR
I earned $___________ income from work in 2014. All copies of 2014-W2 forms are attached.
By signing this form, you agree to provide accurate 2014 income and tax return information. Knowingly
giving false or misleading information (which is determined by the IRS documentation received) may result
in the termination of your Federal Aid eligibility. Such action will result in you becoming responsible for the
payment (out of pocket) of any expenses owed to Kennesaw State University.
WARNING: IF YOU PURPOSELY GIVE FALSE OR MISLEADING INFORMATTION, YOU MAY BE FINED,
SENTENCED TO JAIL, OR BOTH.
Signature___________________________________________ Date__________________________
(Person indicated above)
You must return this form, along with the required documentation to the Office of Student Financial Aid,
located in Kennesaw Hall.
Office of Student Financial Aid, 585 Cobb Avenue NW, MD 0119, Kennesaw, GA 30144
Phone (770) 423-6074 Fax (470) 578-9096
Revised: February 2015