2009-2010 Verification Worksheet Template Page 2
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2C. Student’s Tax Forms and Income Information (all applicants)
Dependent
1. Check only one box below. Tax returns include the 2008 IRS Form 1040, 1040A, 1040EZ, a tax return from Puerto
Rico or a foreign income tax return. If you did not keep a copy of your tax return, request a copy from your tax preparer
or request an Internal Revenue Service form that lists tax account information.
Check here if you are attaching a signed copy of your tax return.
Check here if a signed tax return will be submitted to the school by ______________________(date).
Check here if you will not file and are not required to file a 2008 U.S. Income Tax Return.
2. Funds received for child support and other untaxed income. (See Question 47 of the Free Application for
Federal Student Aid (FAFSA).)
Sources of Untaxed Income
2008 Amount
Sources of Untaxed Income
2008 Amount
$
$
d.
a. Child Support
$
$
e.
b. Workman’s Compensation
$
$
f.
c. Untaxed Pensions
3. If you did not file and are not required to file a 2008 Federal income tax return, list below your employer(s) and any
income received in 2008 (use the W-2 form or other earnings statements if available).
Sources
2008 Income
$
$
$
D. Parent(s)’ Tax Forms and Income Information
1. Check only one box below. Tax returns include the 2008 IRS Form 1040, 1040A, 1040EZ, a tax return from Puerto Rico or a
foreign income tax return. If your parent(s) did not keep a copy of their tax return, request a copy from the tax preparer or request
an Internal Revenue Service form that lists tax account information.
Check here if you are attaching a signed copy of your parents’ tax return(s).
Check here if a signed tax return(s) will be submitted to the school by ______________________(date).
Check here if your parent(s) will not file and are not required to file a 2008 U.S. Income Tax Return.
2. Funds received for child support and other untaxed income. (See Question 95 of the FAFSA.)
Sources of Untaxed Income
2008 Amount
Sources of Untaxed Income
2008 Amount
$
$
d.
a. Child Support
$
$
e.
b. Workman’s Compensation
$
$
f.
c. Untaxed Pensions
3. If your parent(s) did not file and are not required to file a 2008 Federal income tax return, list below your parent(s)’
employer(s) and any income they received in 2008 (use the W-2 form or other earnings statements if available).
Sources
2008 Income
$
$
$
E. Sign this Worksheet
Each person signing this form certifies that all the information reported
WARNING: If you purposely give false or misleading
on it is complete and correct. The student and at least one parent must
information on this worksheet, you may be fined, be
sentenced to jail, or both.
sign and date.
Student
Date
Submit Electronic Signature via Email
Parent
Date
Do not mail this worksheet to the Department of Education. Submit this worksheet to your
Financial Aid Administrator at your school. Don’t forget to sign your tax forms.
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