Fillable 2013-2014-verification-worksheet-independent-student - VerificationWorksheetIndependentStudentm

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2013-2014-verification-worksheet-independent-student - VerificationWorksheetIndependentStudentm

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2013-14 Verification Worksheet
Independent 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 the student’s household, include:
a. The Student.
b. The student’s spouse, if the student is married
c. The student’s or spouse’s children, if the student or spouse will provide more than half of their support
between July 1, 2013 and June 30, 2014, even if the children do not live with the student.
d. Other people, if they now live with the student and the student or spouse provides more than half of their
support and will continue to provide more than half of their support through 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 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.
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
Full Name
Relationship
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
E. Federal Tax Information
Check the box that applies:
1. ☐ St
udent (and spouse, if married) filed/will file a 2012 Federal IRS Tax Return, Puerto Rican, or Foreign Income Tax
Return.
Student (and spouse, if married) must verify 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.
If student is married and filed separately, spouse’s Tax Return Transcript must be submitted.
2. ☐ Student (and spouse, if married) was employed in 2012 and had income, but not required to file a 2012 Federal IRS
Tax Return
List all student’s (and spouse, if married) employers and amount that was earned in the chart below. Submit copies
of all 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 (and spouse, if married) was not employed in 2012, did not have income and 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
F. Asset Information
Do not leave blank. Indicate $0 or N/A if applicable.
1. As of the date you filed the 2013-14 FAFSA, what was your (and your spouse’s) total balance of cash, savings, and
checking accounts?
$
2. As
of the date you filed the 2013-14 FAFSA, what is the net worth of your (and your spouse’s) 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.)
$
3. As
of the date you filed the 2013-14 FAFSA, what is the net worth of your (and your spouse’s) 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.
$
Sig
ning below certifies that all of the information reported is
complete and correct. The student must sign and date.
E
Print Student’s Name Student’s ID Number
Student’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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