Independent Student Verification Worksheet (Page 2 of 4) in pdf

Independent Student Verification Worksheet Page 2

Georgia Tech ID

Office of Scholarships and Financial Aid

Non Tax Filers Only

Please make sure you complete the page in its entirety. If the answer(s) are $0 or not

applicable, please report the information below. Please report the annual amount(s)

received.

I, __________________________________, certify

Student

I did not file and was not required to file a 2015 Federal Income Tax Return(s).

I, __________________________________, certify

Spouse

I did not file and was not required to file a 2015 Federal Income Tax Return(s).

For individuals who signed above, please list the 2015 source(s) of income below and the amount(s) earned from each

source. Also, attach copies of the 2015 W2(s) and/or 1099(s). If reporting Foreign Income, translate the

documentation in English, convert into earnings into U.S. dollars, and have the documentation notarized.

Annual Amount(s)

Student Non-Filer

Spouse Non-Filer

Earnings from Work

Foreign Income

Alimony

Child Support Received

Interest and/or Dividends

Non-Financial Aid Support From Others

(i.e. food, housing, etc.)

Veteran’s Benefits

Worker’s Compensation

Other Income

Note: If earned or untaxed income reported on this form exceeds the filing threshold

pdf/p501.pdf

, additional documentation from the IRS will be required.

225 North Ave. Atlanta, GA 30332-0460

Phone: 404.894.4160 Fax: 404.894.7412

**Faxes are received by a secure server**

Via Email: finaid@gatech.edu

Page

of 4

Independent Student Verification Worksheet Page 2