Verification Form Susquehanna University (Page 2 of 3) in pdf

: ___________________________________________

TUDENT NAME

RANSCRIPT AND

NCOME

NFORMATION

Student: check one box below. Are you or will you be required to file a 2015 Federal Income Tax Return?

 YES. Attach a copy of a Federal Tax Return Transcript from the IRS or update your FAFSA with IRS information by use of

the IRS data retrieval function on the FAFSA website.

 NO. Complete the table below and attach all W-2’s.

Employer name

2015 Wages

Parent(s): check one box below. Are you or will you be required to file a 2015 Federal Income Tax Return?

 YES. Attach a copy of a Federal Tax Return Transcript from the IRS or update the student’s FAFSA with IRS information

by use of the IRS data retrieval function on the FAFSA website.

 NO. Complete the table below and attach all W-2’s. Check here if you will not file and are not required to file a 2015 U.S.

Employer name

2015 Wages

UPPLEMENTAL

UTRITION

SSISTANCE

ROGRAM

ENEFITS

Did any member of your parent’s household receive SNAP benefits (food stamps) during the calendar year 2015?

 YES. Attach official documentation indicating receipt of SNAP benefits.

 NO.

Complete the following table derived from the FAFSA (student questions 44 and 45; parent questions 92 and 93). DO

NOT LEAVE ANY ITEM BLANK. Enter zero if you have no response to the item.

Student

2015 Additional Financial Information

Parent

Education credits from IRS Form 1040-line 50 or 1040A-line 33.

Taxable earnings from need-based employment programs, such as Federal Work-Study and

need-based employment portions of fellowships and assistantships.

Student grant and scholarship aid reported to the IRS in your adjusted gross income. Includes

AmeriCorps benefits (awards, living allowances, and interest accrual payments), as well as

grant or scholarship portions of fellowships and assistantships.

Combat pay or special combat pay. Only enter the amount that was taxable and included in your

adjusted gross income. Do not enter untaxed combat pay reported on the W-2 (Box 12, Code

Q).

Earnings from work under a cooperative education program offered by a college.

Total Student

Total Parent

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Verification Form Susquehanna University Page 2