Verification Worksheet Dependent Student Template - 2015-2016 Page 2
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4NAME ____________________________________________________________________
Last
First
MI
Student ID Number
C. Student Non-Tax 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 2014 income tax return with the IRS. Provide a copy of IRS verification of non-filing of returns for
student.
Check all boxes that apply:
The student and spouse were not employed and had no income earned from work in 2014.
The student and/or spouse were employed in 2014 and have listed below the names of all employers, the amount earned from each employer
in 2014, and whether an IRS W-2 form is provided. (Provide copies of all 2014 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 “V” number at the top.
Employer’s Name
2014 Amount Earned
Was W-2 Provided by Employer?
Example: Suzy’s Auto Body Shop
$2,000.00
Yes
D. Parent Non Tax 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 2014 income tax return with the IRS. Provide a copy of IRS verification of non-filing of returns for parent.
Check all boxes that apply:
Neither parent was employed and had no income earned from work in 2014.
One or both parents were employed in 2014 and have listed below the names of all employers, the amount earned from each employer in
2014, and whether an IRS W-2 form is provided. (Provide copies of all 2014 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. If more space is needed, provide a separate page with the student’s name and
“V” number at the top.
Employer’s Name
2014 Amount Earned
Was W-2 Provided by Employer?
Example: Suzy’s Auto Body Shop
$2,000.00
Yes
Office of Financial Aid
Grace E. Harris Hall Student Service Center
1015 Floyd Ave., 1st Floor
P.O. Box 843026
Richmond, VA 23284-2520
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(804) 828-6669
Fax (804) 827-0060
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VCU is an EEO/AA institution. ENR1314-121
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