2017-2018 Federal Verification Worksheet - Independent Student (Page 3 of 4) in pdf

2017-2018 Federal Verification Worksheet - Independent Student Page 3

Student’s Name: ___________________________

ID: P_________________

Individuals Granted a Filing Extension by the IRS

If an individual is required to file a 2015 IRS income tax return and has been granted a filing extension by

the IRS, provide the following documents:



A copy of IRS Form 4868, ‘‘Application for Automatic Extension of Time to File U.S. Individual Income

Tax Return,’’ that was filed with the IRS for tax year 2015;



A copy of the IRS's approval of an extension beyond the automatic six-month extension if the

individual requested an additional extension of the filing time for tax year 2015; and



A copy of IRS Form W–2 for each source of employment income received for tax year 2015 and, if

self-employed, a signed statement certifying the amount of the individual’s Adjusted Gross Income

(AGI) and the U.S. income tax paid for tax year 2015.

Section III: 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

2015 Amount

IRS W-2

Earned

Provided?

Suzy’s Auto Body Shop (example)

$2,000.00

Yes

Note: We may require you to provide documentation from the IRS that indicates a 2015 IRS

income tax return was not filed with the IRS.

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2017-2018 Federal Verification Worksheet - Independent Student Page 3