DependentVerification (1)

One UTSA Circle | San Antonio, TX 78249 | 210-458-8000 | (800) 669-0919 | [email protected]

Student's First Name: Last:

Office Use OnlyRRAAREQ Code: VERD16 WebX Code: FA_VERIF_FORM Page 1 of 2 (Rev 03/04/15)

Date: ______________ Received By: ______________ Processed By: ______________ .

Documentation submitted by fax or email will not be accepted. Fill out online and print.

2015-2016 Dependent Verification Form

STEP 1: Family Information

myUTSAID

Write the names of all family or household members below. Also write in the name of the college for any family member who will be attending college at least half-time between July 1, 2015 and June 30, 2016, and will be enrolled in a degree or certificate program. If you need more space, attach a separate page. Include people as part of your family or household below only if: They lived with you and your parents and received more than half their support from you and your parents at the time you completed your student aid application, AND They will continue to receive more than half their support from July 1, 2015 through June 30, 2016. Parents and step-parents that you live with must be included.

Full Name Age Relationship to Student College Attending

Student/Self UTSA

Your application was selected for a process known as verification. UTSA will compare your Free Application for Federal Student Aid (FAFSA) with both your and your parents' 2014 federal tax forms, per financial aid program rules (34 CFR, Section 668). If differences arise between your FAFSA and your financial documents, we will correct and reprocess your application. Your financial aid will not disburse until all documents are submitted and the verification process is complete. For faster processing, it is recommended that you and your parents use the IRS Data Retrieval Tool (DRT) on your FAFSA in lieu of submitting your signed tax returns or tax transcripts for 2014. You will then complete this worksheet, sign it, and submit it to our office. If supplemental documentation is submitted (i.e. signed tax returns), please include your name and ID on the top of each page.

Check if you and your parents updated your FAFSA using the IRS DRT in lieu of submitting copies of 2014 tax returns.

Check if you and your parents DID NOT use the IRS DRT on your FAFSA. Check your ASAP account to determine which tax documents need to be submitted to our office.

*If you indicated did not file, skip the check boxes below and proceed to section B.Parent(s)*Student*

A. Indicate in the drop down box the tax filing status (did file or did not file) and inform us if you and your parents were eligible to use the IRS DRT or will be attaching signed copies of 2014 tax returns.

STEP 2: Income Information and/or Tax Forms (section A, B and C)

**Continue Step 2 on next page**

RRAAREQ Code: VERD16 WebX Code: FA_VERIF_FORM Page 2 of 2

myUTSAID Student's First Name: Last:

Office Use Only

With a few exceptions, you are entitled on your request to be informed about the information U.T. San Antonio collects about you. Under Sections 552.021 and 552.023 of the Texas Government Code, you are entitled to receive and review this information. Under Section 559.004 of the Texas Government Code, you are entitled to have U.T. San Antonio correct information about you that is held by us and that is incorrect, in accordance with the procedures set forth in the University of Texas System Business Procedures Memorandum 32. The information that U.T. San Antonio collects will be retained and maintained as required by Texas records retention laws (Section 441.180 et seq.of the Texas Government code) and rules. Different types of information are kept for different periods of time.

STEP 3: Certification Statement Your signature on this document confirms your acknowledgement of the following: The information submitted for review is true and correct to the best of your knowledge. Providing false information may result in reduced eligibility, repayment of aid, or both. During peak seasons, there may be a 7-10 business day processing time for the request. Underestimating the projected income could result in reduced eligibility, repayment of aid, or both in this year or next. You have read each section, provided the required documentation, and understand more may be required upon request.

(Rev 03/04/15)

One UTSA Circle | San Antonio, TX 78249 | 210-458-8000 | (800) 669-0919 | [email protected]

Date: ______________ Received By: ______________ Processed By: ______________ .

B. Regardless of whether or not you filed, list any income that was received from work in 2014. (Do not leave any blanks; enter zero where applicable)

C. Tax filers and non-tax filers must list the following (taxed and untaxed) income received in 2014. (Do not leave any blanks; enter zero where applicable)

2014 Additional Financial Information Student Amount Parent(s) AmountTax Deferred Pensions (W2 Box 12; Codes D, E, F, G, H, or S)

Child Support Received

VA Non-Education Benefits (Disability, Death Pension, DIC, VA WorkStudy)

Other Untaxed/Non-Reported Income

Student Signature: ____________________________ Phone or Email: Date:

Father/Stepfather Signature: ___________________ Mother/Stepmother Signature: __________________ Date:

Employer Names Student Wages Father/Stepfather Wages Mother/Stepmother Wages

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DRTused[0]: Offtaxreturnsattached[0]: OffParenttaxes[0]: Studenttaxes[0]:

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DependentVerification (1)

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