Docstoc

verification-form-independent-student

Document Sample
verification-form-independent-student Powered By Docstoc
					JCCC STUDENT FINANCIAL AID
                        2010-2011 Verification Form – Independent Student
Your application was selected for review in a process called “Verification.” In this process, JCCC will be comparing
information from your application with signed copies of your (and your spouse’s, if you are married) 2009 tax forms and
W-2 forms or other financial documents. By law we have the right to ask you for this information before awarding
Federal aid. If there are differences between your application information and your financial documents, corrections will
need to be made to the Student Aid Report (SAR). Please complete and return this form as soon as possible.


A. Student Information Please print. Please use black ink.

Last Name                                                              First Name                                   M.I.

JCCC ID #                                                 Birthdate
                                                                              -           -
                                                                      Month         Day       Year

Address     _______________________________________                                       Phone      ___________________
                Street Name

_____________________________________ ________ ___________ - ________
                       City                                                       State                 ZIP
If your mailing address has changed, please update that information with Admissions at JCCCAdmissions@jccc.edu or
call (913) 469-3803.

B. Family Information
1. List the people that you (and your spouse) will support between July 1, 2010, and June 30, 2011. Include:
   • Yourself          • Your spouse          • Your dependent children (if you provide more than half of their support)
2. Include other people as part of your family only if:
   • They now live with you and get more than half their support from you (or your spouse) AND
   • They will continue to get more than half their support from you from July 1, 2010, through June 30, 2011.
3. Write in the name of the college for any household member who will be attending college at least half-time between
   July 1, 2010, and June 30, 2011, and will be enrolled in a degree or certificate program.

List yourself first.
                        Full Name                  Age         Relationship                               College

                                                                 Student                                  JCCC




                                                                                                                    page 1 of 4
IVFI11 (0810)
JCCC ID #                                                       Independent

C. Student’s Tax Forms and Income Information
If the answer is zero or the question does not apply to you, enter 0.

1. Check one box only. Acceptable tax returns include the 2009 IRS Form 1040 and all schedules, 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 a copy of an Internal Revenue Service form that lists tax account information.
   I Check and attach signed Federal tax return, W-2 forms and all schedules.
   I Check and complete: Signed tax return will be submitted to the school by ____________________ (date).
   I Check if you will not file and are not required to file a 2009 U.S. Income Tax Return and complete below.

 Complete only if you did NOT file taxes. Sources (Attach a copy of W-2 form or other earnings statements).       2009 Amount




2. Other income (Student).
   In the 2009 Tax Year, did you receive any of the following:

                     Sources of Other Income                                 YES                 NO               2009 Amount

a. Child Support

b. Social Security

c. 401K or Misc.

d. Welfare

e. TANF



3. Title IV Income Exclusions (Student) - Please list any monies received or paid from the following: (See Question 44 on
   the FAFSA.)
   Taxable earnings from Federal Work-Study or other need-based work programs.                                $
   (Provide copy of W-2)

   Allowances and benefits received under the National and Community Service                                  $
   Trust Act of 1993.

   Child support PAID because of divorce or separation by student                                             $
   whose income is reported on the FAFSA.

   List names child support paid for: ___________________________________________________________________




                                                                                                                           page 2 of 4
JCCC ID #                                                          Independent

D. Spouse’s Tax Forms and Income Information (If student is married)
If the answer is zero or the question does not apply to you, enter 0.

1. Check one box only. Acceptable tax returns include the 2009 IRS Form 1040, 1040A, 1040EZ, TeleFile Tax Record, a tax
   return from Puerto Rico or a foreign income tax return. If your spouse did not keep a copy of the tax return, request a
   copy from the tax preparer or a copy of an Internal Revenue Service form that lists tax account information (i.e., tax
   transcript from the IRS).
   I Check if you and your spouse did or will file a joint return.
   I Check and attach signed tax return, W-2 forms and all schedules if your spouse filed a separate return.
   I Check and complete: signed tax return will be submitted to the school by ____________________ (date).
   I Check if your spouse will not file and is not required to file a 2009 U.S. Income Tax Return and complete below.
Complete only if parent(s) did NOT file taxes. Sources (Attach a copy of your parents’ W-2 forms or other earnings statements).         2009 Amount




2. Other income (Spouse/other family members in household).
   In the 2009 Tax Year, did you receive any of the following:
                     Sources of Other Income                                      YES                   NO                        2009 Amount
a. Child Support
b. Social Security
c. 401K or Misc.
d. Welfare
e. TANF


3. Title IV Income Exclusions (Spouse) - Please list any monies received or paid from the following: (See Question 44 on
   the FAFSA.)
   Taxable earnings from Federal Work-Study or other need-based work programs.                                                $
   (Provide copy of W-2)
   Allowances and benefits received under the National and Community Service Trust Act of 1993.                               $

   Child support PAID because of divorce or separation by spouse whose income is reported                                     $
   on the FAFSA.
   List names child support paid for: ___________________________________________________________________

                                                                               WARNING: If you purposely give false or misleading information on this
E. Sign This Form                                                                       worksheet, you may be fined, sentenced to jail, or both.

By signing this worksheet I(we) certify that all the information reported on this worksheet is
                                                                                               Please return this form to:
complete and correct. If married, spouse’s signature is optional. Please use black ink.
                                                                                                                   Johnson County Community College

Student _______________________________________                           Date
                                                                                          -         -              Office of Student Financial Aid, Box 50
                                                                                                                   12345 College Blvd.
                                                                                                                   Overland Park, KS 66210-1299
                                                                                  Month       Day        Year
                                                                                                                   (913) 469-3840

Spouse________________________________________                             Date
                                                                                          -         -              FA Fax (913) 469-2310
                                                                                                                   finaid@jccc.edu
                                                                                  Month       Day        Year
                                                                                                                                            page 3 of 4
JCCC ID #




            page 4 of 4

				
DOCUMENT INFO