V1 Dependent Verification Form Page 2
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1
2Dependent
3. Did anyone in your household pay child support in 2014? (Please check one)
_____ Yes
_____No
*If yes, complete the chart below. NOTE: Don’t include support paid for children included in Section B of this form.
Name of Person Who Paid
Name of Person to Whom Child
Name of Child for Whom
Amount of Child
Child Support
Support was Paid
Support Was Paid
Support Paid in 2014
4 . Did anyone in your household receive Supplemental Nutrition Assistance Program (SNAP) benefits, formerly known as Food
Stamps, in 2013 and/or 2014 ___ Yes ____No
C. Student’s Information
.
1
Check here if your 2014 Federal Income Tax Return has been verified with the IRS using the IRS Data Retrieval Process on
the FAFSA. You do not need to submit a copy of your tax transcript.
Check here if you didn’t use the IRS Data Retrieval Process. You will need a copy of your 2014 tax transcript. To obtain a copy call
the IRS at 1-800-908-9946 or online at
and submit Form 4506T-EZ.
Check here if you will not file and are not required to file a 2014 Federal Income Tax Return. Complete the section below:
2.
If you are NOT required to file a 2014 tax return, list your employers and the amount you earned in 2014.
List every employer even if they did not issue an IRS W-2
Employer’s Name
2014 Amount Earned
IRS W-2 Attached?
*For both 1. and 2.-attach copies of all 2014 IRS W-2 forms issued to the student by employers and Schedules C, E or F if you
own a business
D. Parent(s) Information
.
1
Check here if your 2014 Federal Income Tax Return has been verified with the IRS using the IRS Data Retrieval Process on
the FAFSA. You do not need to submit a copy of your tax transcript.
Check here if you didn’t use the IRS Data Retrieval Process. You will need a copy of your 2014 tax transcript. To obtain a copy call
the IRS at 1-800-908-9946 or online at
and submit Form 4506T-EZ.
Check here if you will not file and are not required to file a 2014 Federal Income Tax Return. Complete the section below:
2. If you are NOT required to file a 2014 tax return, list your employers and the amount you earned in 2014.
List every employer even if they did not issue an IRS W-2 form.
Employer’s Name
2014 Amount Earned
IRS W-2 Attached?
*For both 1. And 2.-attach copies of all 2014 IRS W-2 forms issued to the parent by employers and Schedules C, E or F if you own a business
E. Sign this Worksheet
Certification and Signatures
WARNING: If you purposely give false or
Each person signing this worksheet certifies that all of the information reported
misleading information on this worksheet, you
may be fined, be sentenced to jail, or both.
on it is complete and correct. The student and one parent must sign and date.
Phone: 1-800-616-0412
___________________________________________
Fax:
(608) 342-1281
Student’s Signature
Date
Email:
finaid@uwplatt.edu
Address: 204 Brigham Hall
1 University Plaza
_____________________________________________
Platteville, WI 53818
Parent’s Signature
Date
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