2011-2012 Verification Worksheet

Federal Student Aid Programs

Your application was selected by the U.S. Dept. of Education for review in a process called "verification."  We are required by law to compare the information from your application with the information provided on this form and with your 2010 federal tax information (and your spouse's if you are married, or parents' if you are considered dependent for federal aid purposes).  If there are differences between your application and the documents you've submitted, corrections may need to be made.  We cannot process your financial aid until verification has been completed, so please provide the required documents as soon as possible.

What you need to do:

1. Log in to FAFSA.gov and transfer the IRS data directly to your FAFSA or collect your (and your spouse's or parents') signed Federal income tax forms for 2010.

2. Complete and sign the worksheet - you (and your parent if you are required to provide their income information).

3. Bring or mail the completed worksheet, tax forms if required, and any other forms to the CCC Financial Aid Office.

4. We will compare the information on these documents and make corrections if necessary.

5. Contact us at (315) 255-1743 ext. 2470 or 592-4143 ext. 3004 if you have questions about completing this worksheet.

Last Name                                 First Name                           M.I.                                    Social Security Number

Address (include apt. #)                                                                                     City                                     State                Zip Code

Date of Birth                            Cayuga ID Number                                                            Phone Number (include area code)

      Independent Students: List the people in your household; include (a) yourself, your spouse if married; (b) your children, if you provide more than half of their support from July 1, 2011 through June 30, 2012; and (c) any other people if they now live with you, and you provided more than half of their support and will continue to provide more than half of their support from July 1, 2011 through June 30, 2012. Also write in the name of the college for any family member who will be attending college at least half time between July 1, 2011 and June 30, 2012.

      Dependent Students: List the people in your parent's household; include (a) yourself,  (b) your parent(s) you live with (include stepparent); (c) your parents' other children, even if they don't live with your parent(s), if (1) your parents provide more than half of their support from July 1, 2011 through June 30, 2012, or (2) if they would be required to provide parental information when applying for Federal student aid; and (c) any other people if they now live with your parents, and your parents  provided more than half of their support and will continue to provide more than half of their support from July 1, 2011 through June 30, 2012. Also write in the name of the college for any family member, excluding your parent(s), who will be attending college at least half-time between July 1, 2011 and June 30, 2012, and will be enrolled in a degree program.  If you need more space, attach a separate page.

C.  Student (& Spouse) Tax Forms  (all applicants)

Check one box only.  Tax returns include the 2010 IRS Form 1040, 1040A, 1040EZ, a tax return from Puerto Rico or a foreign income tax return.  If you did not keep a copy of the tax return, log in to FAFSA.gov and transfer the IRS data directly to your FAFSA without any changes or request a copy from your tax preparer or from the IRS at

1-800-829-1040.

□ Check here if you (& your spouse) will not file & are not required to file a 2010 Federal Income Tax Return.

□ Check here if you (& your spouse) have transferred IRS data directly to your FAFSA without any changes.

□ Check & attach SIGNED tax return(s) – No schedules or additional forms required

See Section E below.

D.  Parent(s) Tax Forms and Income Information (dependent students)

Check one box only.  Tax returns include the 2010 IRS Form 1040, 1040A, 1040EZ, a tax return from Puerto Rico or a foreign income tax return.  If your parent(s) did not keep a copy of the tax return, log in to FAFSA.gov and transfer the IRS data directly to your FAFSA without any changes or request a copy from the tax preparer or from the IRS at

1-800-829-1040.

□ Check here if your parent(s) will not file & are not required to file a 2010 Federal Income Tax Return.

□ Check here if your parent(s) have transferred IRS data directly to your FAFSA without any changes.

□ Check & attach SIGNED tax return(s) – no schedules or additional forms required.

See Section E below.

E.  Untaxed Income (all applicants)

Both tax filers and non-tax filers must list any untaxed income received in 2010.  Be sure to enter zeros if no funds were received.  Failure to complete this section will delay the processing of your financial aid.

Student(& Spouse)	Calendar Year 2010	Parent(s) (Step-Parent)
	All Earned Income not reported to the IRS
$	Source:	$
$	Source:	$
	FAFSA 2010 Untaxed Income
$	Child support received for all children.  Do not include foster care or adoption payments	$
$	Workman's Compensation	$
$	Untaxed Pensions	$
$	Other untaxed income – Source:	$

F.  Sign this Worksheet

By signing this worksheet, I (we) certify that all the information reported on this worksheet is complete and correct.  If dependent, at least one parent must sign.  WARNING: If you purposely give false or misleading information on the worksheet, you may be fined, sentenced to jail, or both.

________________________________________________________________

Student Signature                                                                                    Date

________________________________________________________________

Parent Signature (Dependent students only)                                           Date

Return to: Financial Aid Office at Cayuga Community College