Verification Worksheet (Page 3 of 5) in pdf

Student SU ID#: _800____________________

Verification of 2015 Income Information for Nontax Filers

Verification of 2015 Income Information for Student Nontax Filers

The instructions and certifications below apply to the student and spouse, if the student is married. Complete this section if the

student and spouse will not file and are not required to file a 2015 income tax return with the IRS.

Check the box that applies:

The student and spouse were not employed and had no income earned from work in 2015.

The student and/or spouse were employed in 2015 and have listed below the names of all employers, the amount earned

from each employer in 2015, and whether an IRS W-2 form is provided. [Provide copies of all 2015 IRS W-2 forms issued

to the student and spouse by their employers]. List every employer even if the employer did not issue an IRS W-2 form.

If more space is needed, provide a separate page with the student’s name and ID number at the top.

Employer’s Name

IRS W-2

Annual Amount

Provided?

Earned in 2015

(Example) ABC’s Auto Body Shop

Yes

$4,500.00

Total Amount of Income Earned From Work

Verification of 2015 Income Information for Parent Nontax Filers

The instructions and certifications below apply to each parent included in the household. Complete this section if the parents will

not file and are not required to file a 2015 income tax return with the IRS.

Check the box that applies:

Neither parent was employed, and neither had income earned from work in 2015.

One or both parents were employed in 2015 and have listed below the names of all employers, the amount earned from

each employer in 2015, and whether an IRS W-2 form is provided. [Provide copies of all 2015 IRS W-2 forms issued to the

parents by their employers]. List every employer even if the employer did not issue an IRS W-2 form.