Verification Worksheet For Dependent Students Page 2
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Student Verification Worksheet (continued)
C. Parent’s 2015 Income
FIDN:
If your parent’s will file a 2015 Federal Income Tax Return (Form 1040, 1040A, 1040EZ), a tax return from Puerto Rico, or a
1.
foreign income tax return, you may be required to send a signed copy of their return (complete with W-2's and all corresponding
schedules and statements) to the Financial Aid Office.
Which of the following is true? (PLEASE CHECK ONE)
____My parent(s) will not file and are not required to file a 2015 U.S. Income Tax Return.
____I have already sent a copy of my parent’s 2015 income tax return to the Financial Aid Office.
____I have used the IRS Data Retrieval Tool at FAFSA.ed.gov to retrieve and transfer 2015 IRS income information.
____I am mailing my parent’s 2015 income tax return with this form.
____I will use the IRS Data Retrieval Tool at FAFSA.ed.gov to retrieve and transfer 2015 IRS income information.
____I will mail a copy of my parent’s 2015 income tax return to the Financial Aid Office on (date) _____________________.
____My parent(s) has applied for a tax extension. (Please provide a copy of IRS Form 4868)
If your parents worked but were not required to file a 2015 income tax return, list their employers and the amounts of
income that your parents earned from work in 2015 and attach copies of their 2015 W2’s to this form.
EMPLOYER or SOURCE
$
.00
$
.00
List other income and benefits that your parent’s received or paid during 2015 that are not subject to income taxes. Please
2.
attach documentation to verify these figures. Do not include student financial aid.
FOR ZERO AMOUNTS, PRINT "0". DO NOT LEAVE BLANK
Child support PAID by parent(s) listed in Section A of this form:
1. Paid for: ____________________________ Age of child ___ Paid to: ____________________________ Total amount paid in 2015: $_________
2. Paid for: ____________________________ Age of child ___ Paid to: ____________________________ Total amount paid in 2015: $_________
3. Paid for: ____________________________ Age of child ___ Paid to: ____________________________ Total amount paid in 2015: $_________
Child Support Received:
$_______________/mo. x___________mos. = $_________.00
Other Untaxed Income*:
$_______________/mo. x___________mos. = $_________.00
* Untaxed income includes: any income received from any source and not reported on the tax return
D. Certification and Signatures
This form must be signed by the student and at least one parent.
I (we) certify that all the information on this form is true and complete to the best of your knowledge and are willing to
provide documentation to support information reported.
X
X
Student Name (Print)
Student Name (Signature)
Date
X
X
Parent/Guardian Name (Print)
Parent/Guardian Name (Signature)
Date
*WARNING: Purposely give false or misleading information on this worksheet, you may be fined, sentenced to
jail, or both.
If you have any questions about how to complete this form, you can call the Financial Aid Office at (718) 817-3800 (Rose Hill) or at
(212) 636-6700 (Lincoln Center). Failure to properly complete this worksheet will delay the processing of your financial aid.
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