2019-20 Verification Worksheet Indep ende nt Student

Note: Use student’s legal name, not nicknames (i.e. Robert- not Bobby, Bob, Robby, or Rob)

B. HOUSEHOLD INFORMATIONStudent’s marital status as of TODAY: Single Married/Remarried Widowed Separated Divorced List the month and year of your current marital status (i.e. date of divorce or date married): _________________________________

If more space is required, please attach a separate page.

C. INDEPENDENT STUDENT’S 2017 INCOME INFORMATIONCheck the box that applies:

I filed/will file a 2017 Federal IRS Tax Return (Form 1040, 1040A or 1040EZ). Important: If you did not use the IRS Data Retrieval Tool (DRT) to transfer your tax data when you completed the FAFSA and you are eligible to do so, you must do that now. For eligibility, instructions, and a tutorial, visit https://www.ndsu.edu/onestop/finaid/verification/fall_2019_and_spring_2020_verification_forms/ I was employed and had income, but was/am not required to file a 2017 Federal IRS Tax Return: • If you marked this box, you must submit copies of all 2017 W-2 and 1099 Forms (if you do not have these forms,contact your tax preparer or your employer to obtain duplicates) AND submit a 2017 IRS Verification of Non-Filing Letter.A free IRS Verification of Non-Filing Letter can be obtained from the IRS. For instructions visithttps://www.ndsu.edu/onestop/finaid/verification/fall_2019_and_spring_2020_verification_forms/• If you only received cash income in 2017, indicate the amount you received: _________________________________I was not employed, did not have income and was/am not required to file a 2017 Federal IRS Tax Return.• If you marked this box, you are required to submit a 2017 IRS Verification of Non-Filing Letter to our office. A free IRSVerification of Non-Filing Letter can be obtained from the IRS. For instructions visithttps://www.ndsu.edu/onestop/finaid/verification/fall_2019_and_spring_2020_verification_forms/

Student ID # Last Name First Name Telephone #

Full Name Age Write the names of the people in your household in the chart below.

1. Include yourself.

2.

3.

4.

Include your spouse, if you are married as of today (even if you were not married during the 2017 tax year).

Include your children and your spouse’s children, if you or your spouse will provide more than half of their support between July 1, 2019 and June 30, 2020, even if they do not live with you. If the child will be born between July 1, 2019 and June 30, 2020 include the due date.

Include other dependents if they now live with you, you provide more than half of their support and you will continue to provide more than half of their support through June 30, 2020.

Write the age of each household member in the chart below.

Relationship Write the relationship of each household member to the student in the chart below.

College List the name of the college/university for any household member who will be enrolled at least half time (usually 6 or more credits) between July 1, 2019 and June 30, 2020. List only those who are enrolled in a degree, diploma or certificate program at an eligible post-secondary institution. Include children ONLY if they used your parental information when they completed their 2019-20 FAFSA.

Full Name Age Relationship College/University & FAFSA School Code Self NDSU - 002997

A. STUDENT INFORMATION

2019-20 Verification Worksheet Independent Student

D. SPOUSE’S 2017 INCOME INFORMATION (Complete even if you were not married during the 2017 tax year, but are married as of TODAY)

Check the box that applies: Your spouse filed/will file a 2017 Federal IRS Tax Return (Form 1040, 1040A or 1040EZ). Important: If your spouse did not use the IRS Data Retrieval Tool (DRT) to transfer his/her tax data when he/she completed the FAFSA and is eligible to do so, he/she must do that now. For eligibility, instructions, and a tutorial, visit https://www.ndsu.edu/onestop/finaid/verification/fall_2019_and_spring_2020_verification_forms/ Your spouse was employed and had income, but was not required to file a 2017 Federal IRS Tax Return: • If you marked this box, you must submit copies of all 2017 W-2 and 1099 Forms for your spouse. (If you do not havethese forms, your spouse should contact his/her tax preparer or employer to obtain duplicates.) You must also submit a2017 IRS Verification of Non-Filing Letter for your spouse if he/she did not file. A free IRS Verification of Non-Filing Lettercan be obtained from the IRS. For instructions visithttps://www.ndsu.edu/onestop/finaid/verification/fall_2019_and_spring_2020_verification_forms/• If your spouse only received cash income in 2017, indicate the amount they received ________________________Your spouse was not employed, did not have income and was not required to file a 2017 Federal IRS Tax Return.• If you marked this box, you are required to submit a 2017 IRS Verification of Non-Filing Letter for your spouse. A freeIRS Verification of Non-Filing Letter can be obtained from the IRS. For instructions visithttps://www.ndsu.edu/onestop/finaid/verification/fall_2019_and_spring_2020_verification_forms/

E. 2017 CHILD SUPPORT RECEIVED OR PAIDIn 2017 (January 1 – December 31), did you or your spouse (if married) RECEIVE child support because of a divorce, separation or legal requirement? Yes No If yes, tell us who received the child support, the amount received, from whom it was received (name), and for whom it was received (name/age). Example: Jane Doe received $2500 from John Doe for Jack Doe, age 4.

In 2017 (January 1 – December 31), did you or your spouse PAY child support because of a divorce, separation or legal requirement? Do not include support for children in your household as reported in Section B on page 1 of this form.

Yes No If yes, tell us who paid the child support, to whom it was paid (name), total amount paid, and for whom it was paid (name/age). Example: John Doe paid Jane Doe $2500 for Jack Doe, age 4.

F. SIGNATURES – Manually sign with a pen. Unsigned forms or those with digital/electronic/typed signatures will be returned.

Student ID # Last Name First Name

Forms can be submitted in ONE of the following ways: Mailing to: NDSU One Stop ▪ NDSU Dept. 2836 ▪ PO Box 6050 ▪ Fargo, ND 58108-6050 Drop Off On

Campus: 176 Memorial Union (NDSU One Stop)Submit online by visiting https://www.ndsu.edu/onestop/finaid/verification/submitver

Phone: 1-866-924-8969 or (701) 231-6200 Revised: 09/2018

I certify the information on this form is true and complete to the best of my knowledge. I understand that purposely giving false or misleading information may result in fines, penalties, and/or reduction or immediate repayment of aid. I understand that the information provided on this form may affect my/my student’s financial aid eligibility/award.

Student Signature ___________________________________________________ Date ___________________________