2023-2024 Verification Worksheet

2023-2024 Verification Worksheet
A. Student Information
Name

First NameMiddle NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
B. Family Information

Enter the names of all household members in the space(s) below. Also write in the name of the college for any household members, excluding the parent(s), who will be enrolled at least half time, in a degree, diploma, or certificate program between July 1, 2023, and June 30, 2024.

Rows	Full Name	Age	Relationship	College	Will Be Enrolled At Least Half Time?
Household Member 1
Household Member 2
Household Member 3
Household Member 4
Household Member 5
Household Member 6
Household Member 7
Household Member 8

C. Student's Tax & Income Information
Check all that apply
2021 IRS Tax Return Transcript/Tax Return (Student)

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Sources of Untaxed Income

Rows	2021 Amount ($)
Child Support Received
Social Security Benefits
Disability Benefits
Other

If you did not file and are not required to file a 2021 Federal income tax return, list below the source and the amount of any income earned in 2021. If the income was earned from work, please list your employer and provide a copy of your 2021 W2.

Rows	Employer Name	2021 Amount Earned ($)	Attach IRS W2?
Employer 1
Employer 2
Employer 3

IRS W2 (Student)

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D. Parent(s) Tax & Income Information
Check all that apply
2021 IRS Tax Return Transcript/Tax Return (Parent(s))

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Sources of Untaxed Income

Rows	2021 Amount ($)
Child Support Received
Social Security Benefits
Disability Benefits
Other

Rows	Employer Name	2021 Amount Earned ($)	Attach IRS W2?
Employer 1
Employer 2
Employer 3

IRS W2 (Parent(s))

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E. Non-Filer Status with Zero Income
Check all that apply
Non-dependent students must submit an IRS "Verification of Nonfiling (VNF) Letter" or other IRS documentation that clearly states the IRS does not have a tax record for 2021. If you are a non-dependent student, please upload an IRS VNF Letter or other IRS documentation clearly stating that the IRS does not have a tax record for 2021.

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Provide an explanation of means of support:
F. Certification and Signature
Each person signing this form certifies that all the information reported on it is complete and correct. If Dependent, the student and one parent must sign and date.

WARNING: If you purposely give false or misleading information on this worksheet, you may be fined, be sentenced to jail, or both.
Student Signature
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Parent Signature
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Should be Empty:

2023-2024 Verification Worksheet

A. Student Information

B. Family Information

C. Student's Tax & Income Information

D. Parent(s) Tax & Income Information

E. Non-Filer Status with Zero Income

F. Certification and Signature