Stephens College 2010-2011 Verification Worksheet

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					                                                   Stephens College
                                            2010-2011 Verification Worksheet

Your student aid application was selected for review in a              What you should do:
process called “Verification.” We are required by federal law to       1. Complete and sign this Verification Worksheet.
compare your application with information on this form and with        2. Attach signed copies of 2009 federal income tax
signed copies of your 2009 federal tax forms. This includes               returns, pages 1 & 2 only.
spouse’s information if you are married, or parents’ information if        (for student/spouse if independent, or for
you are considered dependent for federal aid purposes. If any             student/parent(s) if dependent for federal purposes).
items have to be corrected, Stephens College will electronically       3. Attach copies of W-2 forms for all wages reported on
correct your file and you will receive updated application                the 2009 federal income tax returns.
information, which allows you to see the changes and results.          4. Don’t skip sections; put N/A or “0” if it doesn’t apply.
                                                                       5. Send all forms to the Stephens College Financial Aid
If any of the required signatures are missing on this form or the
                                                                          Office, 1200 E. Broadway, Campus Box 2124,
family’s tax documents, the document will be returned to you.
                                                                          Columbia, MO 65215 or by fax to 573-876-2320.
The financial aid process will be delayed and the student will not
                                                                       6. Return documents by June 1 if you expect aid to be
receive financial aid until all documents have been signed, fully
                                                                          ready at the start of classes in August.
completed, and returned to the Financial Aid Office.
                                                                       7. Respond promptly to requests for additional
Documentation submitted late (after April 15, 2011, or after
                                                                          information.
withdrawal from the school) will not be reviewed.

  A. Student Information

                                                                                     XXX–XX–
  Last Name                       First Name              M.I.           Last 4 digits of Social Security Number


  Street Address (Include Apartment Number)                              Date of Birth


  City                                      State          Zip           Permanent Phone Number (include area code)
  B. Family Information

  Dependent Student: List the people in your parents’ household, including:
   yourself and your parent(s), using “parent” as defined on the FAFSA (including stepparent), even if you don’t live with your
    parents.
   your parents’ other children, even if they don’t live with your parent(s), if (a) your parents will provide more than half of their
    support from July 1, 2010 through June 30, 2011, or (b) the children would be required to provide parental information when
    applying for federal student aid, and
   other people if they now live with your parents, and your parents provide 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 household 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, diploma, or certificate program. If
  you need more space, attach a separate page.

  Independent Student: List the people in your household, including:
    yourself, and your spouse, if you are married, and
    your children, if you will provide more than half of their support from July 1, 2010 through June 30, 2011, even if they do not
     live with you, and;
    other people if they now live with you and you provide 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 household 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, diploma, or certificate program. If
  you need more space, attach a separate page.

                          Full Name                               Age         Relationship                      College
  1.                                                                              SELF                    Stephens College
  2.

  3.

  4.

  5.

  6.
C. Student’s Tax Forms and Income Information (all applicants)
1. All tax filers must submit the first two pages of a signed copy of a 2009 Federal Income Tax Return, which includes the 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 request a copy of an Internal Revenue Service
   form that lists tax account information. Include copies of all W-2 Forms to document wages from employers. If you are
   married, send a signed copy of your spouse’s return also.
  Check only one box below.
       Check here if you are attaching a signed copy of your tax return with W-2s
       Check here if a signed tax return with W-2s will be submitted to the school by ________________ (date)
       Check here if you will not file and are not required to file a 2009 U.S. Income Tax Return (and see below)
2. If you did not file and are not required to file a 2009 Federal Income Tax Return, list below your employers (and your
   spouse’s employers, if married) and any income received in 2009, and send supporting W-2 Forms or other earnings
   statements.
                                      Sources                                                       2009 Amount
                                                                                   $
                                                                                   $
                                                                                   $
3. Funds received for child support and other untaxed income. (See Question 45 of the Free Application for Federal Student
Aid (FAFSA).)
  Sources of Untaxed Income              2009 Amount            Sources of Untaxed Income             2009 Amount
                                                                       (Continued)
 a. Child Support                $                             d.                             $
 b. Workman’s Compensation       $                             e.                             $
 c. Untaxed Pensions             $                              f.                            $

D. Parent(s)’ Tax Forms (for dependent students)
1. Parents and stepparents of dependent students must submit the first two pages of a signed copy of their 2009 Federal
   Income Tax Return, which includes the IRS Form 1040, 1040A, 1040EZ, a tax return from Puerto Rico or a
   foreign income tax return. If parent(s) did not keep a copy of the tax return, they may request a copy from their tax
   preparer or request a copy of an Internal Revenue Service form that lists tax account information. Include copies of all W-2
   Forms to document wages from employers.
   Check only one box below.
       Check here if you are attaching a signed copy of your parent(s)’ tax return with W-2s
       Check here if a signed tax return with W-2s will be submitted to the school by ________________ (date)
       Check here if your parent(s) will not file and are not required to file a 2009 U.S. Income Tax Return (see below)
2. If your parent(s) did not file and are not required to file a 2009 Federal Income Tax Return, list below your parent(s)’
   employers and any income received in 2009. Send supporting W-2 Forms or other earnings statements.
                                      Sources                                                         2009 Amount
                                                                                   $
                                                                                   $
                                                                                   $

3. Funds received for child support and other untaxed income. (See Question 93 of the Free Application for Federal Student
Aid (FAFSA).)
  Sources of Untaxed Income              2009 Amount            Sources of Untaxed Income             2009 Amount
                                                                       (Continued)
 a. Child Support                $                             d.                             $
 b. Workman’s Compensation       $                             e.                             $
 c. Untaxed Pensions             $                              f.                            $

E. Sign this Worksheet

Each person signing this certifies that all the information reported on it   WARNING: If you purposely give false or misleading information on
is complete and correct. If dependent, at least one parent must sign         this worksheet, you may be fined, be sentenced to jail, or both.
and date.




Student’s Signature                                      Date



Parent’s Signature (Dependent Students Only)             Date