2015-16 Verification Worksheet - Dependent Page 2
ADVERTISEMENT
1
2ANSWER ALL QUESTIONS. INCOMPLETE FORMS WILL BE RETURNED
C. Dependent Student’s Information (all applicants)-
Student Name/ MUID:
1. Did you (student) pay child support in 2014? (Please check one) Yes
No
*
*If Yes, complete the chart below.
(Do not include support paid for children included in Section B of this form.)
Legal Name of Parent/Guardian
Legal Name of Child
Age of Child
Annual 2014 Amount
to Whom Support Was Paid
for Whom Support Was Paid
Paid Per Child
$
$
*
If more space is required, attach a separate page.
2. Check the box that applies:
a.
I filed/will file a 2014 Federal IRS Tax Return, Puerto Rican, or Foreign Income Tax Return.
b.
I was not employed, did not have income and am not required to file a 2014 Federal IRS Tax Return.
c.
I was employed and had income, but am not required to file a 2014 Federal IRS Tax Return and I will list all my
employer(s) (include Marquette) and the amount that was earned in 2014 in the chart below.
COMPLETE ONLY IF BOX C. ABOVE IS CHECKED: Non-Tax Filers with 2014 earnings are federally required to submit a copy
of W-2(s) from each employer to Marquette Central with this form.
Name of Employer
Amount
2014 W-2 Form
2014 W-2 Form
Earned in 2014
Received from employer?
Attached to This Form?
$
Yes
No
Yes
No
$
Yes
No
Yes
No
*If more space is required, attach a separate page.
D. Parent(s)’ Information-
1. Did you pay child support in 2014? (Please check one) Yes*
No
*If Yes, complete the chart below.
(Do not include support paid for children included in Section B of this form.)
Legal Name of Person
Legal Name of
Legal Name of Child
Age of
Annual 2014
Who Paid
Parent/Guardian to Whom
for Whom Support
Child
Amount Paid Per
Child Support
Support Was Paid
Was Paid
Child
$
$
*
If more space is required, attach a separate page.
2. Did you or any people in your family (listed in Section B of this form) receive benefits from the Supplemental
Nutrition Assistance Program (SNAP) in 2013 or 2014? (Please check one) Yes
No
3. Check the box that applies:
a.
I filed/will file a 2014 Federal IRS Tax Return, Puerto Rican, or Foreign Income Tax Return.
b.
I was not employed, did not have income and am not required to file a 2014 Federal IRS Tax Return.
c.
I was employed and had income, but am not required to file a 2014 Federal IRS Tax Return and I will list all my
employer(s) (include Marquette) and the amount that was earned in 2014 in the chart below.
COMPLETE ONLY IF BOX C. ABOVE IS CHECKED: Non-Tax Filers with 2014 earnings are federally required to submit a
copy of W-2(s) from each employer to Marquette Central with this form.
Name of Employer
Amount
2014 W-2 Form
2014 W-2 Form
Earned in 2014
Received from employer?
Attached to This Form?
$
Yes
No
Yes
No
$
Yes
No
Yes
No
*If more space is required, attach a separate page.
E. Manually sign this Worksheet. Forms with electronic/typed signatures will be returned.
Each person signing certifies that all the information reported is complete and correct. The student and at least one
Warning: If you
parent whose information was reported on the 2015-2016 FAFSA must sign and date this worksheet.
purposely give false or
misleading information
____________________________________
___________________________________
on this worksheet, you
Student
Date
Parent
Date
may be fined,
sentenced to jail, or
(
)
Parent Daytime Phone Number (include area code):
both.
Zilber Hall, Suite 121, P.O. Box 1881 Milwaukee, WI 53201-1881 Tel (414) 288-4000 Fax (414) 288-1718 Email:
marquettecentral@marquette.edu
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Legal