2015-16 Verification Worksheet V1 For Federal Student Aid Programs Page 2
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2Student ID#_______________
2. TAX RETURN NONFILERS—
Complete this section if you, your parent (if dependent), or your spouse (if married)
will not file and are not required to file a 2014 income tax return with the IRS.
Check the box that applies:
STUDENT
Parent/Spouse
Check if you will not file and are not required to file a 2014 US Income Tax Return.
Please list below the names of any and all employers for members of the household who did not file 2014 income tax returns. List also
amounts earned from each employer in 2014, attaching W-2 forms from each. Copies of all 2014 W-2 forms issued to you (and, if
married, to your spouse) by employers must be submitted. List every employer even if the employer did not issue an IRS W-2 form.
Employer’s Name
Name
2014 Amount Earned
IRS W-2 Attached?
Suzy’s Auto Body Shop (example)
$2,000.00
Yes
D.
Receipt of SNAP Benefits
You have reported that someone within your household received benefits from the Supplemental Nutrition Assistance Program or
SNAP (formerly known as the Food Stamp Program) sometime during 2013 or 2014. SNAP may be known by another name in
some states. For assistance in determining the name used in a state, please call 1-800-4FED-AID (1-800-433-3243).
You must provide documentation of these benefits before we can continue your application for financial aid. Please contact
your DHS office to request this documentation and submit a copy to the Financial Aid Office as soon as possible. Please contact
the Financial Aid Office at 870-391-3266 if you have further questions.
E.
Child Support Paid Verification
Someone within the household; you, your parent (if dependent), or your spouse (if married), reportedly paid child support in 2014. List below the
names of the persons who paid the child support, the names of the persons to whom the child support was paid, the names of the children for whom
the child support was paid, and the total annual amount of child support that was paid in 2014 for each child. If more space is needed, provide a
separate page that includes the student’s name and ID number at the top.
Name of Person Who Paid
Name of Person to Whom Child
Name of Child for Whom
Annual Amount of Child
Child Support
Support was Paid
Support Was Paid
Support Paid in 2014
Mary Jones(example)
Chris Smith
Billy Smith
$6,000.00
WARNING: If you purposely give false or
misleading information on this worksheet, you
F. Certification and Signature
may be fined, be sentenced to jail, or both.
I certify that all of the information reported on this worksheet
is complete and correct. The student (and parent if dependent)
must sign this worksheet.
________________________________________________________________________________________
Student’s Signature
Date
________________________________________________________________________________________
Parent’s Signature
(only if dependent student)
Date
Revised 1-16-15
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