Tusculum College (Page 4 of 4) in pdf

Student’s Name: ______________________________________________ SSN: __________________________

Verification of Income Earned and Payments to Tax-Deferred Pensions and Retirement Savings

Provide copies of all 2015 IRS W-2 forms received for the student and/or spouse.

The W-2 is used to determine the correct amount of income earned from work and the payments to tax-deferred pensions and

retirement savings as shown in the boxes 12a through 12d.

 Student  Spouse The IRS W-2’s are attached to this worksheet.

 Student  Spouse The IRS W-2’s will be submitted on _____________________.

(Estimated date)

IF YOU OR YOUR SPOUSE WILL NOT FILE AND ARE NOT REQUIRED TO FILE TAXES — Individuals who did not file an IRS

tax return for the relevant tax year will, if they successfully register for Get Transcript Online, receive a PDF page indicating that the IRS has

no record of a tax return being filed for the requested year. Individuals who are not able to successfully register to use the Get Transcript

Online tool will need to request a Verification of Non-filing (VONF) letter using IRS Form 4506-T. Selected applicants who are non filers will

be required to submit confirmation of non-filing from the IRS or other relevant taxing authority.

Contact a Tusculum College Financial Aid Administrator for further assistance.

Section A: Check the box that applies – Student and/or Souse

 Student  Spouse Were not employed and had no income earned from work in 2015.

 Student  Spouse Were employed in 2015 (did not and are not required to file a tax return).

Section B: If you will not file and are not required to file a tax return, list below the names of all the student’s and/or spouse’s

employers and the amount earned from each employer in 2015. Please attach copies of all 2015 W-2 forms issued by employers. List

every employer even if they did not issue a W-2 form. If more space is needed, attach a separate page with the student’s name and

Social Security Number at the top.

Student Name or Spouse’s Name

Employer’s Name

2015 Amount Earned

IRS W-2

Provided?

(if not required to file taxes)

G. Certification and Signatures

By signing this worksheet certifies that all of the information reported on it is complete and correct.

WARNING: If you

_____________________________________________

_____________________________

purposely give

Student’s Signature

false or misleading

Date

information on this

worksheet, you may

be fined, be

Please review your information for accuracy and remember to include the following:

sentenced to jail, or

Student and Spouse’s tax return transcript or the use of the IRS DRT transfer process.

both.

Student and Spouse’s W-2 or wage and tax earnings statement obtained either from the

employer or the IRS.

Submit this worksheet to the Tusculum College Office of Financial Aid. You should make a copy of this worksheet for your records.

Note: If we have reason to believe that any information on this form is inaccurate we may require supplemental documentation.

Office of Financial Aid PO Box 5049 Greeneville, TN 37743

1.800.729.0256 ext. 5377; Fax: 615.250.4968 Email:

financialaid@tusculum.edu

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