2010-2011 Verification Worksheet

Federal Student Aid Programs

Cayuga Community College

Financial Aid Office á 197 Franklin Street, Auburn NY 13021á FAX 315-252-2185

Auburn - 315-255-1743 ext. 2470 á Fulton 315-592-4143 ext. 3004


 

Your application was selected by the U.S. Dept. of Education for review in a process called Òverification.Ó  We are required by law to compare the information from your application with the information provided on this form and with signed copies of your 2009 federal tax forms (and your spouseÕs if you are married, or parentsÕ if you are considered dependent for federal aid purposes).  If there are differences between your application and the documents youÕve 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 should do:

1. Collect your (and your spouseÕs or parentsÕ) signed Federal income tax forms for 2009.

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, and any other documents to the Financial Aid Office at CCC.

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.

 


A. Student Information

 

                                                                                                                                                                                   

Last Name                                 First Name                           M.I.                                    Social Security Number

 

                                                                                                                                                                                   

Address (include apt. #)                                                                                     City                                     State                Zip Code

 

                                                                                                                                                                                   

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

B. Family Information

 

      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, 2010 through June 30, 2011; 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, 2010 through June 30, 2011. Also write in the name of the college for any family member who will be attending college at least half time between July 1, 2010 and June 30, 2011.

 

      Dependent Students: List the people in your parentÕs household; include (a) yourself,  (b) your parent(s) you live with (include stepparent); (c) your parentsÕ other children, even if they donÕt live with your parent(s), if (1) your parents provide more than half of their support from July 1, 2010 through June 30, 2011, 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, 2010 through June 30, 2011. 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, 2010 and June 30, 2011, and will be enrolled in a degree program.  If you need more space, attach a separate page.

 

Full Name                                            Age                Relationship                               College

Example:  Martha Jones                                      24                           Wife                                            City University

                                                                                        Self

 

 

 

 

 

OVER—Second Page must be Completed and Signed

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

Check one box only.  Tax returns include the 2009 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; request a copy from your tax preparer or from the IRS at 1-800-829-1040.

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

□ Check here if you (& your spouse) will not file & are not required to file a 2009 Federal Income Tax Return. See Section E below.

 

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

Check one box only.  Tax returns include the 2009 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, request a copy from the tax preparer or from the IRS at 1-800-829-1040.

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

□ Check here if your parent(s) will not file & are not required to file a 2009 Federal Income Tax Return.

See Section E below.

 

E.  Untaxed Income (all applicants)

Both tax filers and non-tax filers must list any untaxed income received in 2009.  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 2009

Parent(s) (Step-Parent)

 

All Earned Income not reported to the IRS

 

$

Source:

$

$

Source:

$

 

FAFSA 2009 Untaxed Income

 

$

Payments to tax-deferred pensions and savings plans (paid directly or withheld from earnings) including amounts reported on W-2 Form Box 12a-12d, codes D,E,F,G,H & S

$

$

Child support received for all children. Do not include foster care or adoption payments.

$

$

Housing, food, & 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 military housing allowance.

$

$

Veterans noneducation benefits such as Disability, Death Pension, or Dependency & Indemnity Compensation (DIC) and/or VA Educational Work-Study allowances.

$

$

Other untaxed income not reported elsewhere such as workersÕ compensation, disability, IRAÕs, tax exempt interest, untaxed pensions, etc.  Do not include student aid, earned income credit, child tax credit, WIA benefits, or benefits from flexible spending arrangements, e.g. cafeteria plans.

$

$

Money received, or paid on your behalf not reported elsewhere.

$

                                                                                                                                                     

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