2014–2015 Verification Worksheet
Independent Student
Your 2014–2015 Free Application for Federal Student Aid (FAFSA) was selected for review in a process called verification. The law says
that before awarding Federal Student Aid, we may ask you to confirm the information you reported on your FAFSA. To verify that you
provided correct information, the Student Financial Services Office staff will compare your FAFSA with the information on this
worksheet and with any other required documents. If there are differences, your FAFSA information may need to be corrected. You must
complete and sign this worksheet, attach any required documents, and submit the form and other required documents to the Student
Financial Services Office at Clarion University. Clarion may ask for additional information. If you have questions about verification,
contact the Student Financial Services Office as soon as possible so that your financial aid will not be delayed.
A. Independent Student’s Information
_____________________________________________________________
Student’s Last Name
Student’s First Name
Student’s M.I.

____________________________________
Clarion ID Number

_____________________________________________________________
Student’s Street Address (include apt. no.)

____________________________________
Student’s Date of Birth

_____________________________________________________________
City
State
Zip Code

____________________________________
Student’s Cell Phone Number

_____________________________________________________________
Student’s Home Phone Number (include area code)
B. Independent Student’s Family Information
List below the people in your household. Include:
 Yourself.
 Your spouse, if you are married.
 Your children, if any, if you or your spouse will provide more than half of the children’s support from July 1, 2014,
through June 30, 2015, even if the children do not live with you.
 Other people if they now live with you and you provide more than half of their support and will continue to provide more
than half of their support through June 30, 2015.
Include the name of the college for any household member who will be enrolled at least half time, in a degree, diploma, or
certificate program at a postsecondary educational institution any time between July 1, 2014, and June 30, 2015. If more space
is needed, attach a separate page with your name and Clarion ID number at the top.
Full Name

Age

Relationship
Self

V1

College
Clarion University of PA

Will be Enrolled at
Least Half Time

C.

Independent Student’s Income Information to Be Verified

1. TAX RETURN FILERS—Important Note: If you (or your spouse, if married) filed, or will file, an amended 2013 IRS tax
return or filed separate 2013 income tax returns, you must contact the Student Financial Services Office before completing this
section.
Instructions: Complete this section if you (and your spouse, if married) filed or will file a 2013 IRS income tax return. The
best way to verify income is by using the IRS Data Retrieval Tool (IRS DRT) that is part of the electronic FAFSA application
(www.fafsa.ed.gov ). Typically, no further documentation is needed to verify 2013 income information that was transferred
into the student’s FAFSA using the IRS DRT if that information was not changed.
In most cases, for electronic tax return filers, 2013 IRS income tax return information for the IRS DRT is available within 2-3
weeks after the 2013 electronic IRS income tax return has been accepted by the IRS. Generally, for filers of 2013 paper IRS
income tax returns, the 2013 IRS income tax return information is available for the IRS DRT within 6-10 weeks after the 2013
paper IRS income tax return has been received by the IRS. Contact the Student Financial Services Office if more information
is needed about using the IRS DRT.
Check the box that applies:
I, the student, have used the IRS Data Retrieval Tool in FAFSA on the Web to transfer my (and, if married, my spouse’s)
2013 IRS income information into my FAFSA, either on the initial FAFSA or when making a correction to the FAFSA.
Clarion will use the IRS information that was transferred in the verification process.
I, the student, have not yet used the IRS Data Retrieval Tool in FAFSA on the Web, but will use the tool to transfer 2013
IRS income tax return information into the student’s FAFSA once the 2013 IRS income tax return has been filed.
I, the student, am unable or choose not to use the IRS Data Retrieval Tool in FAFSA on the Web, and instead will provide
the school with a 2013 IRS Tax Return Transcript.
To obtain a 2013 IRS Tax Return Transcript, go to www.IRS.gov and click on the “Get Transcript of your Tax
Records” link under the heading “Tools”. You will then have the choice between receiving your transcript online or by
mail. We recommend choosing “Get Transcript Online” because you will be able to instantly view and print a copy of
your 2013 Tax Return Transcript. When ordering your transcript online, you will be asked to sign in with your user ID. If
you have not created an account before, please create a new account now. Once you have created an account and you have
signed in, you will be able to select a 2013 Tax Return Transcript.
If you choose “Get Transcript by Mail”, please enter all required information and select a 2013 Tax Return Transcript.
Your transcript will generally be sent to you via the US mail within 5-10 calendar days.
Check here if an IRS Tax Return Transcript is attached to this worksheet.
Check here if an IRS Tax Return Transcript will be submitted to Clarion later. Verification cannot be completed
until the IRS tax return transcript has been submitted to the Student Financial Services Office.
2. TAX RETURN NONFILERS— Complete this section if you, the student (and, if married, your spouse), will not file and are
not required to file a 2013 income tax return with the IRS.
Check the box that applies:
The student (and, if married, the student’s spouse) was not employed and had no income earned from work in 2013.
The student (and/or the student’s spouse if married) were employed in 2013 and have listed below the names of all
employers, the amount earned from each employer in 2013, and whether an IRS W-2 form is attached. Attach copies of all
2013 W-2 forms issued to you (and, if married, to your spouse) by employers. List every employer even if the employer did
not issue an IRS W-2 form. If more space is needed, attach a separate page with your name and Clarion ID at the top.
Employer’s Name
2013 Amount Earned
Suzy’s Auto Body Shop (example)
$2,000.00(example)

V1

Student’s Name: ______________________________________________ Clarion ID: ______________________
D. Independent Student’s Other Information to Be Verified
1. Complete this section if someone in the student’s household (listed in Section B) received benefits from the Supplemental
Nutrition Assistance Program or SNAP (formerly known as food stamps) any time during the 2012 or 2013 calendar years.
SNAP may be known by another name in some states. For assistance in determining the name used in a state, please call 1800-4FED-AID (1-800-433-3243).
One of the persons listed in Section B of this worksheet, Family Member: _____________________, received SNAP
benefits in 2012 or 2013. If asked by my school, I will provide documentation of the receipt of SNAP benefits during 2012
and/or 2013.
2. Complete this section if you or your spouse, if married, paid child support in 2013.
Either I, or if married my spouse who is listed in Section B of this worksheet, paid child support in 2013. I have indicated
below the name of the person who paid the child support, the name of the person to whom the child support was paid, the
names of the children for whom child support was paid, and the total annual amount of child support that was paid in 2013
for each child. If asked by my school, I will provide documentation of the payment of child support. If you need more
space, attach a separate page that includes your name and Clarion ID at the top.
Name of Person Who Paid
Child Support

Name of Person to Whom Child
Support was Paid

Name of Child for Whom
Support Was Paid

Marty Jones(example)

Chris Smith

Terry Jones

Amount of Child
Support Paid in
2013
$6,000.00

E. Certification and Signature
Each person signing below certifies that all the
Information reported is complete and correct.

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

_________________________________________________
Student’s Signature

_________________________________
Date

_________________________________________________
Spouse’s Signature (if student is married)

_________________________________
Date

Do not mail this worksheet to the U.S. Department of Education.
Submit this worksheet to:
Student Financial Services Office
B-16 Carrier Hall
Clarion University of Pennsylvania
Clarion, PA 16214
(You should make a copy of this worksheet for your records.)

V1