Fillable 2013-2014-verification-worksheet-dependent-student - VerificationWorksheetDependentStudentm

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2013-2014-verification-worksheet-dependent-student - VerificationWorksheetDependentStudentm

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2013-14 Verification Worksheet
Dependent Student
Office of Financial Aid
.
Phone: 734.487.0455
.
Fax: 734.487.4281
.
Email: financial_aid@emich.edu
.
Web: www.emich.edu/finaid
A. Household Information
Student ID
E
Name
Las
t 4 Digits of Social Security #
XXX-XX-
Telephone
B. Ho
usehold Information
1. Write the names of all the people in your parent(s)’ household, including:
a. Yourself.
b. Your parent(s). If parents are divorced, indicate the parent you lived with the most during the last 12 months.
If you did not live with one parent more than the other, list the parent who supplied more than half of your
support. Include your step-parent if parent is remarried.
c. Your parent(s)’ other children, if your parents will provide more than half of their support between July 1, 2013
and June 30, 2014, or if the children would be required to provide parental information when applying for
federal aid.
d. Other dependents, if they now live with your parent(s), your parent(s) provide more than half of their support
and will continue to provide more than half of their support between July 1, 2013 and June 30, 2014.
2. Include the date of birth of each person and their relationship to the student.
3. Add the name of the college for any household member who will be enrolled in a degree, diploma, or certificate
program at least half-time between July 1, 2013 and June 30, 2014.
If more space is needed, provide a separate page with student’s name and EMU ID number at the top.
C. Child Support Paid
Did you pay child support due to divorce, separation, or as a result of a legal requirement for any children not included in
Section B of this form?
Yes. Complete table below. No. Proceed to Section D.
Name of person who paid child
support
Name of person to whom
child support was paid
Name of child for whom
support was paid
Amount of child
support paid in 2012
$
$
$
Note: If we have reason to believe that the information regarding child support paid is not accurate, we may require
additional documentation.
Full Name
Relationship to you
Name of College
1.
Self
Eastern Michigan University
2.
3.
4.
5.
6.
Student ID
E
Office of Financial Aid
.
Phone: 734.487.0455
.
Fax: 734.487.4281
.
Email: financial_aid@emich.edu
.
Web: www.emich.edu/finaid
D. Food Assistance
Did you or any person in your household (listed in Section B of this form) receive benefits from the Supplemental Nutrition
Assistance Program (SNAP) e.g., Michigan Food Assistance Program, Bridge Card in 2011 or 2012?
Yes No
E. Parent Federal Tax Information
Check the box that applies:
1. ☐ Pa
rent(s) filed/will file a 2012 Federal IRS Tax Return, Puerto Rican, or Foreign Income Tax Return.
Please verify parent(s) 2012 income by using the IRS Data Retrieval Tool as a part of the FAFSA on the Web at
FAFSA.gov or submit an IRS Tax Return Transcript. Directions for both options are listed at the bottom of this page.
2. ☐ Parent(s) was employed and had income, but will not file and are not required to file a 2012 Federal IRS Tax Return
List all parent(s)’ employers and amount that was earned in 2012 in the chart below. Submit copies of all parent(s)
2012 W-2 forms.
Name of Employer
Amount Earned in 2012
2012 W-2 Form received from
employer?
$
Yes
No
$
Yes
No
$
Yes
No
3. ☐ Parent(s) not employed, did not have income and are/were not required to file a 2012 Federal IRS Tax Return.
F. Student Federal Tax Information
Check the box that applies:
1. ☐ St
udent filed/will file a 2012 Federal IRS Tax Return, Puerto Rican, or Foreign Income Tax Return.
We may require verification of your 2012 income. Check your requirements in the financial aid eligibility section of
your my.emich account for clarification of your requested documents. If we are requesting your Federal Tax Return
use the IRS Data Retrieval Tool as a part of the FAFSA on the Web at FAFSA.gov or submit an IRS Tax Return
Transcript. Directions for both options are listed at the bottom of this page.
2. ☐ Student was employed in
2012 and had income but will not file and are not required to file a 2012 Federal IRS Tax
Return. List all student’s employers and amount that was earned in 2012 in the chart below. Submit copies of all
student 2012 W-2 forms.
Name of Employer
Amount Earned in 2012
2012 W-2 Form received
from employer?
$
Yes
No
$
Yes
No
$
Yes
No
3. ☐ Student was not employed in 2012, did not have income and was not required to file a 2012 Federal IRS Tax Return.
Retrieving Tax Information for 2012:
IRS Data Retrieval Tool directions:
It is preferable that the student log back into
his/her FAFSA and request the IRS database
match as this will expedite the verification
process. Log into student’s FAFSA, select
“Make FAFSA Corrections,” and go to the
Financial Information section of the form. Follow
instructions to determine if you are eligible to
use this tool.
Tax Return Transcript directions:
To obtain a 2012 IRS Tax Return Transcript, go to
www.IRS.gov and click on the “Order a Return or Account
Transcript” link, or call 1-800-908-9946. Make sure to request
the “IRS Tax Return Transcript” and not the “IRS Tax Account
Transcript.” Use the Social Security Number and date of birth
of the first person listed on the 2012 IRS income tax return,
and the address on file with the IRS (normally this will be the
address used on the 2012 IRS income tax return).
Student ID
E
Office of Financial Aid
.
Phone: 734.487.0455
.
Fax: 734.487.4281
.
Email: financial_aid@emich.edu
.
Web: www.emich.edu/finaid
G. Asset Information
Student Asset
Information
Parent Asset
Information
$ ________________
As of the date you filed the 2013-14 FAFSA, what was your total
balance of cash, savings, and checking accounts?
$ ________________
$ ________________
As of the date you filed the 2013-14 FAFSA, what is the net worth of
your investments?
Investments include: real estate (do not include the family home),
trust funds, UGMA and UTMA accounts, money market funds,
mutual funds, certificates of deposit, stocks, bonds, other securities,
Coverdell savings accounts, 529 college savings plans. Do not
include: the value of life insurance, retirement plans (pension funds,
annuities, noneducational IRAs, Keogh plans, etc.)
$ ________________
$ ________________
As of the date you filed the 2013-14 FAFSA, what is the net worth of
your current business and/or invest farm?
Business or farm value includes the current market value of land,
buildings, machinery, equipment, inventory, etc. Do not include your
primary home. Do not include the net worth of a family owned and
controlled small business with not more than 100 full-time or full-time
equivalent employees.
$ ________________
Ea
ch person signing below certifies that all of the information
reported is complete and correct. The student and one parent
whose information was reported on the FAFSA must sign and date.
E
Print Student’s Name Student’s ID Number
Student’s Signature Date
Parent’s Signature Date
WARNING: If you purposely give false or
misleading information you may be fined,
be sentenced to jail, or both.
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Completed 11 February 2020

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