Fillable Office of Student Financial Aid Verification Worksheet 2020-2021 (North Carolina A&T State University)

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Office of Student Financial Aid Verification Worksheet 2020-2021 (North Carolina A&T State University)

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Page 1 of 4
VWKST 2020-2021
Office of Student Financial Aid
Verification Worksheet 2020-2021
Your 2020–2021 Free Application for Federal Student Aid (FAFSA) was selected for review in a process called verification. To verify that you provided
correct information, we will compare your FAFSA with the information on this institutional verification document and with any other required documents.
If there are differences, your FAFSA information may need to be corrected. You and a parent whose information was reported on the FAFSA
must complete, sign and submit this Verification Worksheet and attach any required documents to the Office of Student Financial Aid (SFAO). If
you have questions about verification, contact the SFAO.
___________________________________________________________ Banner: XXX_________________________
Student Last Name Student First Name MI Last 6 digits only
Email Address
_____________________________________________________________________________________________________
Permanent Address (include apt #) City State Zip Code
_______________________________ _______________________________
Home Telephone Number (include area code) Cell Number (include area code)
STEP 1: Please check the appropriate box and include only the information for the checked box.
List the names of all family members who reside in the household.
If additional space is needed, please add additional sheet(s)
Dependent Students (List yourself first under “Self”) Independent Students (List yourself first.)
Full Name Age Relationship College Attending for 2020-2021 Date of Birth
Self
NC A&T State University
Include yourself, your parent(s) including step-parent,
parents’ dependent children, and other people living in the
household, if your parent(s) will provide more than half of
their support from July 1, 2020 through June 30, 2021.
Write in the name of the college for any family member
(excluding your parent(s) who will be attending college in
a degree program at least half-time between July 1, 2020
and June 30, 2021.
Include yourself, your spouse (if married), your children
and any other individuals that you will provide more than
half of their support from July 1, 2020 through June 30,
2021.
Write in the name of the college for any family member
who will be attending college in a degree program at
least half-time between July 1, 2020 and June 30, 2021.
Page 2 of 4
VWKST 2020-2021
Name__________________________________________________ Banner: XXX______________________
Last 6 digits only
STEP 2: Tax Forms and Income Information
You are encouraged to use the IRS Data Retrieval Tool to transfer information to your FAFSA. If you do not use
the IRS Data Retrieval, you should submit a 2018 Federal tax transcript from the IRS by visiting www.irs.gov or
calling 1-800-908-9946 or a signed copy of your 2018 Federal tax return.
Instructions: Please check the appropriate box that applies to your filing status:
To Be Completed by STUDENT (Dependent/Independent): (Please check the appropriate box)
I filed a 2018 Federal Income Tax Return and used the IRS Data Retrieval Tool, or attaching a copy of my 2018 IRS Tax Return Transcript or a
signed copy of the 2018 Federal Tax Return.
My spouse and I filed a 2018 Federal Income Tax Return. (If filed separately, you both must submit a copy of the 2018 IRS Tax Return Transcript or
a signed 2018 Federal Tax Return).
I filed an amended tax return for 2018? If yes, I am attaching a copy of the tax return transcript or 2018 Federal Tax Return and a signed 1040X.
I was not employed and not required to file a 2018 Federal Income Tax Return. (Independent Students Only) A copy of the IRS Non-Tax
Filer Letter must be submitted.
I was employed in 2018 (Yearly amount earned $_______________) and not required to file a 2018 Federal Tax Return. (Independent
Students Only) A copy of the IRS Non-Tax Filer Letter must be submitted.
To Be Completed By PARENT(S): (Please check the appropriate box)
I/We filed a 2018 Federal Income Tax Return and used the IRS Data Retrieval Tool, or attaching a copy of the 2018 IRS Tax Return Transcript or a
signed copy of the 2018 Federal Tax Return.
My spouse and I filed a 2018 Federal Income Tax Return. (If filed separately, you both must submit a copy of the 2018 IRS Tax Return Transcript or
a signed 2018 Federal Tax Return).
I/We filed an amended tax return for 2018? If yes, I am attaching a copy of the tax return transcript or 2018 Federal Tax Return and a signed 1040X.
I/We were not employed and not required to file a 2018 Federal Income Tax Return. (A copy of the IRS Non-Tax Filer Letter must be
submitted.)
I/We were employed in 2018 (Yearly amount earned $ ___________) and not required to file a 2018 Federal Tax Return. (A copy of the IRS
Non-Tax Filer Letter must be submitted.)
For Non-Tax Filer (Parent(s) Only) If your parents did not file a 2018 tax return please submit a copy of their 2018 Non-Filer Letter
from the IRS.
For Non-Tax Filer (Independent Student/Spouse Only) If you and your spouse did not file a 2018 tax return please submit a copy
of you and your spouse 2018 Non-Filer Letter from the IRS.
Instructions for obtaining an IRS Verification of Non-Filing Letter:
All non-tax filers are required to provide an IRS Verification of Non-Filing Letter dated on or after October 1, 2019 that indicates that a 2018 IRS income
tax return was not filed with the IRS. After receiving the Verification of Non-Filing Letter from the IRS, include the student’s Banner ID, then submit to
the Office of Student Financial Aid.
• Paper Request Form- IRS Form 4506-T- complete lines 1-4, check box 7, enter 12/31/2019 for box 9,
check signatory attestation box, sign, date, and submit to the IRS as instructed. Mail or fax to your
respective IRS location depending upon your state of residence as shown on page 2 of the 4506-T form.
• Online Request - Go to www.IRS.gov/transcript, and then choose either “Get Transcript Online” or “Get
Transcript by Mail.” Get transcript online will give you instant delivery via PDF, whereas get transcript by
mail, you will receive a copy within 5-10 business days. Make sure to request a 2018 Verification of Non-
Filing Letter.
• Telephone Request - 1-800-908-9946, after following prompts, select option 2 to request an IRS
Verification of Non-Filing Letter and then enter “2018.”
Page 3 of 4
VWKST 2020-2021
Name__________________________________________________ Banner: XXX______________________
Last 6 digits only
STEP 3: Student and Parent’s 2018 Untaxed Income
Independent Student: Please indicate below any of the following that apply to you (and your spouse) for the 2018 tax year.
Dependent Student: Please indicate below any of the following that apply to you and your parent(s) for the 2018 tax year.
If left blank, the value is assumed to be “0” for processing.
Sources of Untaxed Income Student/Spouse Parent
Payments to tax-deferred pension and retirement savings plans (paid directly or withheld from earnings), including,
but not limited to, amounts reported on the W-2 forms in Boxes 12a through 12d, codes D, E, F, G, H and S. Do
not include amounts reported in code DD (employer contributions toward employee health benefits).
$
$
IRA deductions and payments to self-employed SEP, SIMPLE, Keogh and other qualified plans from IRS Form
1040 Schedule 1-total from lines 28 + 32.
$
$
Child support received for any of your parents’ children. (yearly amount) Do not include foster care or adoption
payments.
$
$
Tax exempt interest income from IRS Form 1040-line 2a.
$
$
Untaxed portions of IRA distributions and pensions from IRS Form 1040 - line 4a minus 4b)
Exclude rollovers. If negative, enter a zero here.
$
$
Housing, food and other living allowances paid to members of the military, clergy and others (including cash
payments and cash value of benefits). Do not include the value of on-base military housing or the value of a basic
$
$
Veterans’ non-education benefits, such as Disability, Death Pension, or Dependency & Indemnity Compensation
(DIC) and/or VA Educational Work-Study allowances. (yearly amount)
$
$
Other untaxed income not reported in items 44a through 44g, such as workers’ compensation, disability, etc. Also
include the untaxed portions of health savings accounts from IRS Form 1040 Schedule 1—line 25.
Do not include extended foster care benefits, student aid, earned income credit, additional child tax credit, welfare
payments, untaxed Social Security benefits, Supplemental Security Income, Workforce Investment Act educational
benefits, on-base military housing or a military housing allowance, combat pay, benefits from flexible spending
arrangements (e.g., cafeteria plans), foreign income exclusion or credit for federal tax on special fuels.
$
$
Earnings from work under a cooperative education program (co-op) offered by a college. (yearly amount)
$
$
Money received, or paid on your behalf (e.g., bills), not reported elsewhere on this form (yearly amount). Combat
pay or special combat pay. Only enter the amount that was taxable and included in your parents’ adjusted gross
$
$
Education credits (American Opportunity, Hope or Lifetime Learning tax credits) from IRS Form1040 Schedule
3 – Line 50.
$
$
Taxable earnings from need-based employment programs, such as Federal Work-Study and need-based employment.
$
$
Taxable student grants and scholarship aid reported to IRS in you and/or your parents adjusted gross income.
Includes AmeriCorps benefits (awards, living allowances and interest accrual payments), as well as grant and
$
$
Page 4 of 4
VWKST 2020-2021
Name__________________________________________________ Banner: XXX______________________
Last 6 digits only
(Please Check All Applicable Boxes Below)
• Child Support - Did you, one or both of your parents listed in the household on Step 1 pay child support in 2018?
Yes No (If yes, complete the section below)
Name of Person Who Paid
Child Support
Name of Person to
Whom Child Support
Was Paid
Name of Child for Whom
Support Was Paid
Date of Birth for
Whom Child
Support Was Paid
Yearly Amount of
Child Support Paid
in 2018
$
$
$
$
Certification
By signing below, each person certifies that all the information reported on this form is complete and correct.
Warning: If you purposely give false or misleading information on this worksheet, you may be fined, sentenced to jail, or both.
Please provide a hand-written signature (not a computer-generated signature)
Student Signature__________________________________ Date___________________________
Parent Signature___________________________________ Date____________________________ ________________________
(For dependent students) Relationship to Student
Mail or Fax completed form to:
North Carolina Agricultural and Technical State University
Office of Student Financial Aid
1601 E. Market Street
Greensboro, North Carolina 27411
Telephone #: 336-334-7973 Fax #: 336-334-7954
North Carolina Agricultural and Technical State University does not discriminate against employees, students, or applicants
based on age, color, disability, gender, gender identity, gender expression, national origin, political affiliation, race,
religion, sexual orientation, genetic information, veteran status, or any other basis protected by law.
STEP 4: Child Support Paid
STEP 5: Required Signatures
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Completed 23 July 2020

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