2015-16 Verification Worksheet - Independent Page 2
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2ANSWER ALL QUESTIONS. INCOMPLETE FORMS WILL BE RETURNED
C. Independent 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
Annual 2014 Amount
to Whom Support Was Paid
for Whom Support Was Paid
Child
Paid Per 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.
D. Spouse’s Information (if student is married)-
1. Did you (spouse) 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
Annual 2014 Amount
to Whom Support Was Paid
for Whom Support Was Paid
Child
Paid Per Child
$
$
*
If more space is required, attach a separate page.
2. Check the box that applies:
a.
Spouse filed/will file a 2014 Federal IRS Tax Return, Puerto Rican, or Foreign Income Tax Return.
b.
Spouse not employed, did not have income and am not required to file a 2014 Federal IRS Tax Return.
c.
Spouse employed and had income, but am not required to file a 2014 Federal IRS Tax Return and will list all
spouse’s 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. If married, the spouse’s signature
Warning: If you
is optional.
purposely give false or
misleading information
_____________________________________ ___________________________________
on this worksheet, you
may be fined,
Student
Date
Spouse
Date
sentenced to jail, or
(
)
Student 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
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