Verification Worksheet for Independent Students 2008-2009

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Verification Worksheet for Independent Students 2008-2009 Powered By Docstoc
					                                                      Verification Worksheet for Independent Students
                                                                        2008-2009
Your application was selected for review.       What you should do:
Rutgers will be comparing the information       1. Collect your (and your spouse’s) financial documents (signed Federal income tax forms, all schedules).
on this worksheet with the information you      2. Carefully review, complete and sign the worksheet.
submitted on your Free Application for
Federal Student Aid (FAFSA). If there are       3. Do not leave any item blank. Enter “0” if item does not pertain to you.
differences, Rutgers will update your data      4. Return the signed, completed worksheet, tax forms and related documents to your regional Office of
with the federal processor. Please respond         Financial Aid.
promptly to avoid delays in processing your           Rutgers must review the requested information under the financial aid program rules (34 CFR, Part 668).
financial aid.


A. Student Information                            -            -                      ____________          ____________       (______)_______________
                                      Social Security Number                          Date Of Birth (DOB)   School #             Area Code and Phone Number
                                      Your Social Security Number is required to process your Federal Student Aid.

_________________________________________________                            __________________________________________________________
Last Name                     First Name                           M.I.        Address                                                    Apt. #

_________________________________________________                           __________________________________________________________
Email                                                                          City                                               State             ZIP


B. Family Information - List the people in your household, include:
           yourself (and spouse), and
           your children, if you provide more than half of their support from July 1, 2008 through June 30, 2009, and
           other people who live with you, and you provide more than half of their support and will continue to provide more than half of their support.

Write the names of all household members. Indicate the name of the college for any household member who will attend college at least half-time between
July 1, 2008 and June 30, 2009, and who will be enrolled in an undergraduate degree, or certificate program. Attach a separate page, if necessary.

                    Full Name                                              Age           DOB            Relationship                      College




C. Tax Forms and Income Information (All applicants complete Section C)                         Tax returns include the 2007 IRS Form 1040, 1040A,
1040EZ, a tax return from Puerto Rico or a foreign income tax return. If you (or your spouse) did not keep a copy of the tax return, request a copy from
the tax preparer or request an Internal Revenue Service form that lists tax account information.


                     All applicants / ChECk ONE BOx                                                          If married / ChECk ONE BOx
   Signed tax return(s) enclosed                                                          You and your spouse did or will file a joint return
   Signed tax return(s) will be submitted to Rutgers by _____________                     My spouse filed a separate tax return. Spouse’s signed tax return is
   (date)                                                                                 enclosed
   I will not file and I am not required to file a 2007 Federal income tax                Signed tax return(s) will be submitted to Rutgers by ______________
   return.                                                                                (date)
                                                                                          My spouse will not file and is not required to file a 2007 Federal
                                                                                          income tax return.

If you did not file and are not required to file a 2007 Federal                        If your spouse did not file and is not required to file a 2007 Federal
income tax return, list below any employer(s) and any income, or                       income tax return, list below any employer(s) and any income, or
any in-kind support, received in 2007 (use the W-2 form or other                       any in-kind support, received in 2007 (attach W-2 form or other
earnings statements if available).                                                     earnings statements if available).

  Sources                                                 2007 Amount                     Sources                                             2007 Amount
                                                      $                                                                                   $
                                                      $                                                                                   $
                                                      $                                                                                   $

                                                                             -OVER-
Calendar Year 2004
Calendar Year 2004      questions, on page 3, for the student and, on page 5, for the student’s parents.
                        questions, on page 3, for the student and, on page 5, for the student’s parents.
                        questions, on page 3, for the student and, on page 5, for the student’s parents.
Calendar Year 2004
Calendar Year 2004
Calendar Year 2004                           Worksheet A
                                             Worksheet A
     D. Worksheets. Please report annual amounts for the calendar year 2007.
                                        Report Annual Amounts
                                             Worksheet A         Worksheet A
                                                             Report Annual Amounts
ent/Spouse                                                       Worksheet A
                                                             Report Annual Amounts                                                      Parent(s)
ent/Spouse
or Page 3
                                                                            Worksheet A
                                                             Report Annual Amounts
                                                             Report Annual Amounts                                                      Parent(s)
                                                                                                                                       For Page 5
ent/Spouse
or Page 3
ent/Spouse                                                                                                                              Parent(s)
                                                                                                                                       For Page 5
                                                                                                                                        Parent(s)
ent/Spouse             Earned income credit from IRS Form 1040—line 65a; 1040A—line 41a; 1040EZ—line 8a; or                             Parent(s)
or Page 3
or Page 3              Earned income credit from IRS Form 1040—line 65a; 1040A—line 41a; 1040EZ—line 8a; or                             Student 5
                                                                                                                                       For Page /SpouSe
                                                                                                                                       For Page 5
or Page 3              TeleFile—line credit from IRS Form 1040—line 65a; 1040A—line 41a; 1040EZ—line 8a; or
                       Earned income L
                       Earned income L                                       66a;               40a;
                       TeleFile—line credit from IRS Form 1040—line 65a; 1040A—line 41a; 1040EZ—line 8a; or
                                                                                                                                  $
                                                                                                                                  $
                                                                                                                                       For Page 5
                       Earned income credit from IRS Form 1040—line 65a; 1040A—line 41a; 1040EZ—line 8a; or
                       Additional child
                       TeleFile—line L tax credit from IRS Form 1040—line 67 or 1040A—line 42                                     $
                                                                                                                                  $
                       Additional child                                           67 or
                       TeleFile—line L tax credit from IRS Form 1040—line Needy1040A—line 42
                                                                                        Families (TANF). Don’t include
                       Welfare benefits, including Temporary Assistance for 67 or 1040A—line 42
                                                                                                                                  $
                                                                                                                                  $
                       Additional child tax credit from IRS Form 1040—line Needy Families (TANF). Don’t include
                                                      Temporary
                       Welfare benefits, includingfrom IRS Assistance for 67 or   68                   41                         $
                                                                                                                                  $
                       Additional child tax credit housing. Form 1040—line Needy1040A—line 42
                       food stamps or subsidized
                       Welfare benefits, including Temporary Assistance for             Families (TANF). Don’t include
                                                                                                                    include       $
                       food stamps or subsidized housing.                                                                         $
                       Welfare benefits, including Temporary Assistance for Needy Families (TANF). Don’t include
                       Social Security benefits received, for
                       food stamps or subsidized housing. all household members as reported in student’s household                $
                                                                                                                                  $
                       Social Security
                       food(or parents’benefits received, for all household members as reported in student’s household
                       size stamps or subsidized housing. were not taxed (such as SSI). Report student’s household                $
                                         household size), for                                           benefits household
                       Social Security benefits received, that all household members as reported in student’spaid to
                       size (or parents’ household size), that were not taxed (such as SSI). Report benefits paid to
                       Social Securityparents’ column, andallall household members as reported in student’spaid to
                       parentsSecuritybenefits received for benefitsnot taxed (such as SSI). in the student’s column.
                                parents’ household size), for household directly you listed Report benefits paid
                       Social in the benefits received,that were paidmembersto student in Section B (Family to   household
                       size (or in the parents’ column, and benefits paid directly to student in the student’s column.            $
                       parents parents’                                                                                           $
                                                                                                                                  $
                       size (or in the parents’ not taxed,and benefitsnot taxed (such student Report benefits paid to
                                          were column, such were
                       Information) that household size), thatas SSI. paid directly toas SSI). in the student’s column.
             Enter      Worksheet A question
                     inparents in the parents’ column, and benefits paid directly to student in the student’s column.
                                                                                                   Enter in Worksheet
                                                                                                        A       column.           question
                                                                                                                                  $
                                                                                                                                  $
             Enter      Worksheet A question
                     inparents                                                                          A
                                                                                                   Enter in Worksheet             question
                                                                                                                                  $
               -- on Worksheet A question
             Enter inPage 3                                                                      on Page 5--
                                                                                    Enter in Worksheet A question$
                                                                                                          question
             Enter inPage 3
               -- on Worksheet A question
               -- on Page 3                                      Worksheet B
                                                                                  Total forin WorksheetA5-- $ $
                                                                                    Enter Worksheet A question
                                                                                                 on Page 5--
                                                                                                on Page
                                                                                                                 $
               -- on Page 3                                      Worksheet B                     on Page 5--    $$
                                                             Report Annual Amounts
                                                                 Worksheet B
                                                             Report Annual Amounts
                                                                            B
                                                                 Worksheet Worksheet B
 nt/Spouse                                                   Report Annual Amounts                               Parent(s)
 nt/Spouse
or Page 3
 nt/Spouse
                                                             Report Annual Amounts                               Parent(s)
                                                                                                                For Page 5
                                                                                                                 Parent(s)
 nt/Spouse
or Page 3
 nt/Spouse                                                                                                                              Parent(s)
                                                                                                                                        tudent/S
                                                                                                                                       SParent(s)
                                                                                                                                       For Page 5pouSe
or Page 3
or Page 3              Payments to tax-deferred pension and savings plans (paid directly or withheld from earnings),                   For Page 5
or Page 3              Payments to tax-deferred pension and reportedplans (paid directly or withheld from earnings),
                                     but not limited to, amounts savings on the W-2 Form
                       including, to tax-deferred pension and savings plans (paid directly or withheld from earnings),
                       Payments to tax-deferred pension and savings plans (paid directlyin Boxes 12afrom earnings),
                                                                                                               through 12d,
                                                                                                                                       For Page 5
                                                                                                                                       For Page 5
                       Payments to tax-deferred pension and savings plans (paid directly or withheld from earnings),
                       including, but not limited to, amounts reported on the W-2 Form in Boxes 12a through 12d,
                                                                                                  or withheld
                       PaymentsE, F, not H, and S. amounts reported on the W-2 Form in Boxes 12a through 12d,
                       codes D, but G, limited to,
                       including, but not limited to, amounts reported on the W-2 Form in Boxes 12a through 12d,
                       including, but G, H, and S. amounts reported on the W-2 Form in                                            $
                       codes D, E,
                       including, F, and and S.
                       codes D, E, F, notH, payments to self-employed SEP, SIMPLE, andBoxes 12a through 12d,
                       IRA deductions limitedS.       to,                                                                         $
                       codes D, E, F, G, H, payments to self-employed SEP, SIMPLE, and Keogh and other qualified
                       codes D, E, F, G, H, and S.
                       IRA deductions and and
                                          G,                                                        Keogh and other qualified
                                                                                                                                  $
                                                                                                                                  $
                                                                                                                                  $
                       IRA deductions Form 1040 total of lines 25 + 32 or 1040A line 17
                       plansdeductions and payments to self-employed SEP, SIMPLE, and Keogh and other qualified
                              from IRS and payments to self-employed SEP, SIMPLE, and Keogh and other qualified                   $
                       IRA deductions Form 1040 total of lines 25 + 32 or 1040A line 17
                       plans from IRS and payments                       28 SEP, SIMPLE, and Keogh and other qualified
                       IRA from IRS Form 1040 for to self-employed32 or 1040A line 17 or adoption payments.                       $
                       plans from IRS Form 1040 total of lines 25Don’t or 1040A line 17                                           $
                       Child                              total children. + 32 include foster care
                                                            all of lines 25 + 32
                       plans support you received total children. children. Don’tfoster care adoption payments.                   $
                                                                                                                                  $
                       plans support you your spouse
                       Child                                                     include include foster
                       Child from IRS orreceived for all children. Don’t or 1040A 1040A or care or adoption payments.
                       Child support youForm 1040 for received for allDon’t include foster care or adoption payments.
                                                                of lines 25 +                 line 17                             $
                       Child support you received for all IRS Form Don’t include foster care orline 8b payments.
                       Tax exempt interest incomefor all children. Don’t include foster care or adoption payments.
                               support you received from children. 1040 line 8b or
                       Child support      you received      all                                          adoption                 $
                                                                                                                                  $
                                                                                                                                  $
                       Tax exempt interest income from IRS Form 1040 line 8b or 1040A line 8b                                     $
                                                                                                                                  $
                       Tax exempt interest income from IRS Form 1040 line 8b or 1040A line 8b                                     $
                       Tax exempt interest income from IRS Form 1040 line 8b or 1040A line 8b
                                                                                  line 8b 2555EZ line 8b
                       Tax exempt interest income from IRS Form 1040 line 43 oror 1040A line 18
                       Foreign income exclusion from IRS Form 2555                                                                $
                       Foreign income exclusion from IRS Form 2555 line 45 or 2555EZ line 18
                                                                                      43
                       Foreign income exclusion from IRS Form 2555 line 43 or 2555EZ line 18                                      $
                                                                                                                                  $
                       Foreign income exclusiondistributions from IRS Form 43 or 2555EZ line 18 15b) or
                       Untaxed portions of IRA from IRS Form 2555 line 1040 lines (15a minus
                       Foreign income exclusiondistributions from IRS Form 43 or 2555EZ line 18 15b) or
                                                       from IRS Form 2555 line                                                    $
                                                                                                                                  $
                                   portions of IRA                                    1040 lines (15a minus
                       Untaxed portions of IRA distributions from IRS Form 1040 lines (15a minus 15b) or
                       Untaxed lines (11a                                                                                         $
                       1040A                  of IRA 11b). Exclude rollovers. If negative, enter a minus 15b)
                       Untaxed portions ofminusdistributions from IRS Form 1040 lines (15azero here. or
                       1040A lines (11a IRA 11b). Exclude rollovers. If 1040 lines (15azero here.
                                                                                      negative, enter minus 15b)
                       Untaxed lines (11a minusdistributions from IRS Form negative, enter a zero here. or                        $
                       1040A portions ofminus 11b). Exclude rollovers. Iflines (16a minusa16b) or 1040A lines (12a
                       Untaxed portions pensions from IRS Form 1040 negative,                                                     $
                       1040A portions ofminus 11b). Exclude rollovers. Iflines (16a minusa16b) or 1040A lines (12a
                       1040A lines (11a minus 11b). Exclude rollovers. If negative, enter a zero here.
                       Untaxed lines (11a pensions from IRS Form 1040 lines (16a enter zero here.                                 $
                                                                                                                                  $
                       minus 12b). Exclude rollovers. If IRS Form 1040
                       Untaxed portions of pensions from negative, enter a zero here. minus 16b) or 1040A lines (12a              $
                       minus 12b). Exclude rollovers. If IRS Form 1040 lines (16a
                       Untaxed portions of pensions fromnegative, enter a zero here. minus 16b) or 1040A lines (12a
                       minus 12b). Exclude rollovers. If negative, enter a zero here.                                             $
                                                                                                                                  $
                       minus 12b). Exclude on special fuels from IRS Form 4136 line 10 nonfarmers only
                       Credit for federal tax rollovers. If negative, enter a zero here.                                          $
                                                                                                                                  $
                       Credit for federal tax on special fuels from IRS Form 4136 line 10 nonfarmers only                         $
                       Housing, federal tax on living fuels from paid to members line 10 nonfarmers only
                                                                                                 17
                       Credit forfood, and otherspecial allowancesIRS Form 4136 of the military, clergy, and others               $
                       Credit forfood, and otherspecial allowances IRS Form 4136 of the military, clergy, and others
                       Housing, federal tax on living fuels from paid to members line 10 nonfarmers only others
                                                                                                   military, clergy, and          $
                       (including cash payments and cash value of benefits)                                                       $
                       Housing, food, and other living allowances paid to members of the military, clergy, and others
                                                                                    .
                       (including noneducation benefits such as Disability, Death Pension, or Dependency & Indemnity              $
                       Veterans’ cash payments and cash value of benefits)
                       (includingnoneducation benefits such as Disability, Death Pension, or Dependency & Indemnity
                                                                                                                                  $
                       Veterans’ cash(DIC), and/or VA Educational Work-Study allowances Dependency & Indemnity
                       Compensation
                                            payments and cash value of benefits)                                                  $
                                                                                                                                  $
                       Veterans’ noneducation benefits Educational Work-Study Pension, or .Dependency
                                                                                  Death allowances
                       Compensation (DIC), and/or VA such as Disability,elsewhere on Worksheets A and& Indemnity                  $
                                                                                                                                  $
                       Any other untaxed income or benefits not reported                                             B, such as
                       Compensation (DIC), and/or benefits not reported elsewhere on Worksheets A and B, such as
                                                               Educational Work-Study allowances
                       Any other untaxed income or VA portions of railroad retirement benefits, Black and B, such as
                                                                                                 Worksheets A Lung Benefits,      $
                       workers’ compensation, untaxed
                       Any other untaxed income or benefits not reported elsewhere onbenefits, Black Lung Benefits,
                                                                                                 Worksheets A and B, such as
                       workers’ compensation, untaxed portions of railroad retirement benefits, Black Lung Benefits,
                       disability, etc.
                       disability,compensation, untaxed portions of railroad retirement benefits, Black Lung Benefits,
                       workers’ etc.
                       disability, etc.
                       Don’t include student aid, Workforce Investment Act educational benefits,benefits, or if you are from
                       Don’t include student aid, Workforce Investment Act educational combat pay benefits                         $
                       Don’t include benefits from flexible spending arrangements, e.g. cafeteria plans. or benefits from
                       flexible spending arrangements, e.g., Investment Act
                       not a tax filer, orstudent aid, Workforce cafeteria plans educational benefits, or benefits from
                                                                                                  benefits,                        $
                       Don’t include student aid, Workforce Investment Act
                       flexible spending arrangements, e.g., cafeteria plans educational benefits, or benefits from                $
                                                                                                                                   $
                                received, or paid on youre.g., cafeteriabills), not reported not reported this form
                                                              behalf (e.g., plans
                       Money received, or paid on your or your spouse’s behalf (e.g., bills)elsewhere onelsewhere on this
                       Money spending arrangements,
                       flexible                                                                                                    XXXXXXXXXXXXX
                                                                                                                                   $
                       Money received, or paid on your behalf (e.g., bills), not reported elsewhere on this form
                                                                                                 elsewhere on this form            $
                                                                                                                                   XXXXXXXXXXXXX
                                                                                                                                   XXXXXXXXXXXXX
                       form.
             Enter     Money received,B question behalf (e.g., bills), not reported elsewhere onin Worksheet B
                     in Worksheet or paid on your
             Enter in Worksheet B question                                                           Enter this form
                                                                                              Enter in Worksheet B question
                                                                                                                                   XXXXXXXXXXXXX
                                                                                                                                  question
                                                                                                       Worksheet B question
                                                                                            Total for Worksheet B 5--$
               -- on Worksheet B question
               -- on Page 3
             Enter inPage 3
               -- on Page 3
                                                                                                          on Page         $
                                                                                              Enter in Worksheet B question
                                                                                                                   on Page 5--
                                                                                                                   on Page 5--          $
                                                                                                                                        $
               -- on Page 3                                      Worksheet C
                                                                 Worksheet C                                       on Page 5--          $
                                                                 Worksheet C
                                                                    Annual Amounts
                                                             Report Annual Amounts
                                                                 Worksheet Worksheet C
                                                                            C
                                                             Report Annual Amounts
 nt/Spouse
                                                             Report                                                                     Parent(s)
 nt/Spouse
 nt/Spouse
                                                             Report Annual Amounts
                                                             Report Annual Amounts                                                      Parent(s)
                                                                                                                                        Parent(s)pouSe
or Page 3                                                                                                                                tudent/S
                                                                                                                                       SParent(s)5
or Page 3
 nt/Spouse
or Page 3
 nt/Spouse
                                                                                                                                        For Page 5
                                                                                                                                       For Page 5
                                                                                                                                        Parent(s)
                                                                                                                                        For Page
or Page 3              Education credits (Hope and Lifetime Learning tax credits) from IRS Form 1040 line 49 or
                       Education credits (Hope and Lifetime Learning tax credits) from IRS Form 1040 line 49 or                        For Page 5
or Page 3              Education credits (Hope and Lifetime Learning tax credits) from IRS Form 1040 line 49 or                        For Page 5
                       1040A line 31
                       1040A line 31 (Hope and Lifetime Learning tax credits) from IRS Form 1040 line 49 or                       $
                                                                                                                                  $
                       Education credits
                       Education credits (Hope and Lifetime Learning tax credits) from IRS Form 1040 line 49 or
                       1040A line 31                                                                                              $
                       Child support you paid because of divorce or of divorce or separation or legal requirement.                $
                       1040A line 31 or your spouse paid becauseseparation or as a result of aas a result of a legal
                       Child support 31 paid because of divorce or separation or as a result of a legal requirement.
                       1040A line you paid because of divorce or separation or as a result of a legal requirement.
                       Child support you                                                                                          $
                       Child include support because of in your or your parents’) a result of
                       Don’t support you paidfor children in your (or separation or ashousehold. a legal requirement.
                       Don’t support you paidfor children divorce (orseparation or as a result of a legal requirement.
                       Child include support for children divorce (or your parents’) household.
                       requirement. support because of in your or your parents’) household.
                       Don’t include                                                                                              $
                       Don’t include support for children in your (or your parents’) household.
                       Don’t include support for children in your (or your parents’) household.                                   $
                                                                                                                                  $
                       Taxable earnings from need-based employment programs, such as Federal Work-Study and need-
                       Taxable earnings from need-based employment programs, such as Federal Work-Study and need-                 $
                                                                                                                                  $
                       Taxable earnings from need-based employment programs, such
                       based employment portions of fellowships and programs, such as Federal Work-Study and need-
                       Taxable earnings from need-based employmentassistantships. as Federal Work-Study and need-
                       based employment portions of fellowships and assistantships. as Federal Work-Study and need-               $
                                                                                                                                  $
                       based employment portions of fellowships and programs, such
                       Taxable earnings from need-based employmentassistantships.                                                 $
                       based employment portions ofaid reported to the IRS in your (or your parents’) adjusted gross
                               grant and scholarship fellowships the assistantships.
                       Student grant and scholarshipof fellowships and IRS in your or your spouse’s adjusted grossgross
                       based employment portions aid reported toto the IRS in your (or your parents’) adjusted gross              $
                       Student grant and AmeriCorpsaid reported and assistantships.(or your parents’) adjusted                    $
                                                                                                                   income.
                                Includes scholarship benefits (awards,                         parents’) accrual
                                                                                            and interest accrual
                       Student AmeriCorps benefits aid reported to the living and interest and interest adjusted well
                       income. grant and scholarship(awards, living allowances,allowances, accrual payments), as grossas
                       Includesgrant and scholarship aid reported to the IRS in your (or your parents’) adjusted gross
                                                                          IRS fellowships and assistantships.
                                                                                  your
                       Student Includes AmeriCorpsscholarship portions of inallowances, and interest accrual
                       income.                          benefits (awards, living
                       payments), as well as grant or benefits (awards, living allowances, and interest accrual                   $
                       income. Includes AmeriCorps fellowships                                 assistantships.                    $
                       grant or Includes portions of
                       income. scholarship as grant or scholarship and assistantships.
                       payments), as wellAmeriCorps benefits (awards, living allowances, and interest accrual
                                                                   portions of fellowships and assistantships.                    $
                       payments), as well as grant or scholarship portions of fellowships and assistantships.                     $
                       payments), as well as grant or scholarship portions of fellowships and assistantships.                     $
           Enter in Worksheet C question                                                     Worksheet C
                                                                                  Enter in Worksheet C question
                                                                               Total for Worksheet C question
           Enter in Worksheet C question
                  in Worksheet C question
           Enter inPage 3
              -- on Worksheet C question                                          Enter in Worksheet C5--$
                                                                                  Enter in Worksheet C5--
                                                                                                  on Page question
                                                                                                              question
                                                                                                  on Page question   $
                                                                                                                     $
           Enter Page 3
              -- on Page 3
                 on                                                               Enter in Worksheet C5--
                                                                                                      Page
                                                                                                  on Page 5--        $
              --                                                                                  on                 $
              -- on Page 3                                                                        on Page 5--
        E. Signatures I (We) certify that all the information reported on this worksheet is complete and correct.    $
                                                                                                                                                Warning: If you purposely
        _______________________________________________ 6_______________________________________________                                        give false or misleading
                                                     Page of 6
        Student                         Date                 of 6
                                                      Page 6 of 6                                                                               information on this
                                                     Page 6Spouse                        Date
                                                                                                                                                worksheet, you may be fined,
                                                      Page 6 of 6
        __ __ __ - __ __ - __ __ __ __                                                                                                          sentenced to jail, or both.
        Social Security Number