2014-15 Dependent Verification Worksheet Template (Page 2 of 2) in pdf

Student Name_________________________________________ Campus ID __________________________________

For complete directions on submitting tax information, go to:

E. Student’s Tax Forms and Income Information (Check appropriate box)

I filed 2013 taxes and used the IRS Data Retrieval Tool to complete the FAFSA. I did not make changes to the FAFSA fields after

the retrieval tool was used. This can be done at anytime in lieu of returning a Tax Return Transcript.

I filed 2013 taxes and have attached a Federal Tax Return Transcript (or Tax Account Transcript if changes were made after

filing). To obtain a free Tax Return Transcript, go to

or call 1-800-908-9946. Be sure to request a Tax Return

Transcript and not a Tax Account Transcript. You can request a transcript as soon as your tax return is processed by the IRS.

I will not file and am not required to file a 2013 Federal Tax Return. List below your employer(s) as well as any income

received in 2013. Attach your W-2s when submitting this form. If you didn’t earn income in 2013, enter “0” below.

Sources of Income/Places of Employment

2013 Income

F. Parent(s) Tax Forms and Income Information (Check appropriate box)

I filed 2013 taxes and used the IRS Data Retrieval Tool to complete the FAFSA. I did not make changes to the FAFSA fields

after the retrieval tool was used. This can be done at anytime in lieu of returning a Tax Return Transcript.

I filed 2013 taxes and have attached a Federal Tax Return Transcript (or Tax Account Transcript if changes were made after

filing). To obtain a free Tax Return Transcript, go to

or call 1-800 908-9946. Be sure to request a Tax Return

Transcript and not a Tax Account Transcript. You can request a transcript as soon as your tax return is processed by the IRS.

I will not file and am not required to file a 2013 Federal Tax Return. List below your parent(s) employer(s) and any income

they received in 2013. Attach your parent(s) W-2s when submitting this form. If your parent(s) didn’t earn income in

2013, enter “0” in the table below and you must also complete Section G.

Sources of Income/Places of Employment

2013 Income

Earned By

G. Low Income Statement

If your parent(s) did not file a 2013 Federal Tax Return and did not list any other sources of income/resources above in section F,

attach a separate statement explaining how the household was able to pay for necessities such as housing, food, transportation, etc.

Please be specific and provide amounts and sources of income

I have attached a low income statement.

H. Sign this worksheet

By signing this worksheet, we certify that all the information reported on it is complete and correct. At least one parent must sign.

______________________________________________

Student

Date

Parent

Date

Return this form to: UW-Stout Financial Aid Office

WARNING: If you purposely give false or

210 Bowman Hall, 802 S Broadway St

misleading information on this worksheet, you

Menomonie, WI 54751

may be fined, be sentenced to jail, or both.

Phone: 715-232-1363 / Fax: 715-232-5246

DVF Feb 2014

2014-15 Dependent Verification Worksheet Template Page 2

Related Articles

Related forms

Related Categories