2015-2016 Comprehensive Verification Worksheet
Dependent Student
Your 2015–2016 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 and your parent(s) reported on your FAFSA.
To verify that you provided correct information, the Student Financial Services (SFS) 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 and at least one parent must complete and sign this worksheet, attach any required documents, and submit the form and
other required documents to the SFS Office. Clarion may ask for additional information.

A. Dependent Student’s Information
______________________________________________________________
Student’s Last Name
Student’s First Name
Student’s M.I.

___________________________________
Student’s Clarion ID Number

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

___________________________________
Student’s Date of Birth

______________________________________________________________
City
State
Zip Code

___________________________________
Student’s Alternate or Cell Phone Number

______________________________________________________________
Student’s Home Phone Number (include area code)

B. Dependent Student’s Family Information
List below the people in your parent(s)’ household. Include:
 The student.
 The parents (including a stepparent), even if the student doesn’t live with the parents.
 Your parent(s)’ other children if your parent(s) will provide more than half of the children’s support from July 1, 2015,
through June 30, 2016, or if the other children would be required to provide parental information if they were completing a
FAFSA for 2015–2016. Include children who meet either of these standards even if the children do not live with the
parent(s).
 Other people if they now live with your parent(s) and your parent(s) provide more than half of their support and will
continue to provide more than half of their support through June 30, 2016.
Include the name of the college for any household member, excluding your parent(s), who will be enrolled at least half time
in a degree, diploma, or certificate program at an eligible postsecondary educational institution any time between July 1, 2015,
and June 30, 2016. Please contact the SFS Office if your parent(s) will be enrolled in a degree program at least half-time
during the 2015-16 academic year.
Full Name

Age

Relationship
Self

V5

College
Clarion University

Will be Enrolled at
Least Half Time

C. Dependent Student’s Income Information to Be Verified
1.

TAX RETURN FILERS—Important Note: If the student filed, or will file, an amended 2014 IRS tax return, the student must
contact the SFS Office before completing this section.
Instructions: Complete this section if the student, filed or will file a 2014 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 2014 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, 2014 IRS income tax return information for the IRS DRT is available within 2-3
weeks after the 2014 electronic IRS income tax return has been accepted by the IRS. Generally for filers of 2014 paper IRS
income tax returns, the 2014 IRS income tax return information is available for the IRS DRT within 6-10 weeks after the 2014
paper IRS income tax return has been received by the IRS. Contact the SFS Office if more information is needed about using
the IRS DRT.
Check the box that applies:
The student has used the IRS Data Retrieval Tool in FAFSA on the Web to transfer 2014 IRS income tax return
information into the student’s FAFSA, either on the initial FAFSA or when making a correction to the FAFSA.
The student has not yet used the IRS Data Retrieval Tool in FAFSA on the Web, but will use the tool to transfer 2014 IRS
income tax return information into the student’s FAFSA once the 2014 IRS income tax return has been filed.
The student is unable, or chooses not to use the IRS Data Retrieval Tool in FAFSA on the Web, and instead will provide
the school with a 2014 IRS Tax Return Transcript.
To obtain a 2014 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 2014 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 2014 Tax Return Transcript.
If you choose “Get Transcript by Mail”, please enter all required information and then select “2014 Tax Return
Transcript”. Your transcript will generally be sent to you via US mail within 5-10 calendar days.
Check here if the student’s IRS Tax Return Transcript is attached to this worksheet.
Check here if the student’s 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 SFS Office.

2.

TAX RETURN NONFILERS—Complete this section if the student, WILL NOT file AND is not required to file a 2014
income tax return with the IRS.
Check the box that applies:
I was not employed and had no income earned from work in 2014.
I was employed in 2014 and have listed below the names of all the student’s employers and the amount earned from each
employer in 2014.
Employer’s Name
Suzy’s Auto Body Shop (example)

V5

2014 Amount Earned
$2,000.00(example)

Student’s Name: __________________________________________ Clarion ID: __________________________

D. Parent’s Income Information to Be Verified—Note: If two parents were reported in Section B of this worksheet, the
instructions and certifications below refer and apply to both parents.
1. TAX RETURN FILERS—Important Note: If your parent(s), filed or will file, an amended 2014 IRS tax return or filed
separate 2014 tax forms, you must contact the SFS Office before completing this section.
Instructions: Complete this section if the parents filed or will file a 2014 IRS income tax return(s). 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 2014 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, 2014 IRS income tax return information for the IRS DRT is available within 2-3
weeks after the 2014 electronic IRS income tax return has been accepted by the IRS. Generally, for filers of 2014 paper IRS
income tax returns, the 2014 IRS income tax return information is available for the IRS DRT within 6-10 weeks after the 2014
paper IRS income tax return has been received by the IRS. Contact the SFS Office if more information is needed about using
the IRS DRT.
Check the box that applies:
The parent(s) have used the IRS Data Retrieval Tool in FAFSA on the Web to transfer 2014 IRS income tax return
information into the student’s FAFSA, either on the initial FAFSA or when making a correction to the FAFSA.
The parent(s) have not yet used the IRS Data Retrieval Tool in FAFSA on the Web, but will use the tool to transfer 2014
IRS income tax return information into the student’s FAFSA once the 2014 IRS income tax return has been filed.
The parent(s) are unable or choose not to use the IRS Data Retrieval Tool in FAFSA on the Web, and instead will provide
the school with a 2014 IRS Tax Return Transcript.
To obtain a 2014 IRS Tax Return Transcript, go to www.IRS.gov and click on the “Get Transcript of your Tax
Records” link under the heading “Tools”. Your parent(s) will then have the choice between receiving the transcript online
or by mail. We recommend choosing “Get Transcript Online” because they will be able to instantly view and print a copy
of their 2014 Tax Return Transcript. When ordering their transcript online, they will be asked to sign in with their user ID.
If they have not created an account before, they should do so now. Once they have created an account and signed in, they
will be able to select a 2014 Tax Return Transcript.
If they choose “Get Transcript by Mail”, please enter all required information and select “2014 Tax Return Transcript”.
Their transcript will generally be sent to them via US mail within 5-10 calendar days.
If your parents filed separate 2014 IRS income tax returns, 2014 Tax Return Transcripts must be provided for both.
Check here if the parent(s)’ IRS Tax Return Transcript(s) is attached to this worksheet.
Check here if the parent(s)’ IRS Tax Return Transcript(s) will be submitted to Clarion later. Verification cannot be
completed until the IRS tax return transcript has been submitted to the SFS Office.
2. TAX RETURN NONFILERS—Complete this section if your parent(s), WILL NOT file AND is not required to file a 2014
income tax return with the IRS.
Check the box that applies:
My parent(s) was not employed and had no income earned from work in 2014.
My parent(s) was employed in 2014 and has listed below the names of all the parent’s employers and the amount earned
from each employer in 2014. Attach SIGNED copies of all 2014 IRS W-2 forms issued to the parent(s) by employer(s).
List every employer even if they did not issue an IRS W-2 form.
Employer’s Name

V5

2014 Amount Earned

E. Parent’s Other Information to Be Verified
1. Complete this section if someone in your parent’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 2013 or 2014 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).
The parent(s) certify that __________________________, received SNAP benefits in 2013 or 2014. If asked by Clarion’s
SFS Office, I will provide documentation of the receipt of SNAP benefits during 2013 and/or 2014.

2. Complete this section if one of your parents in the household paid child support in 2014.
One (or both) of your parents listed in Section B of this worksheet, or you, paid child support in 2014. List 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 2014 for each
child. If asked by Clarion, I will provide documentation of the payment of child support. If you need more space, attach a
separate page that includes the student’s name and Clarion ID number at the top.

Name of Person Who Paid
Child Support

Name of Person to Whom Child
Support was Paid

Name and Age of Child for
Whom Support Was Paid

Marty Jones

Chris Smith (example)

Terry Jones (Age 15)

Amount of Child
Support Paid in
2014
$6,000.00

F. Student’s Other Information to Be Verified
1. Identity and Statement of Educational Purpose
**To Be Signed at Clarion University:
The student must appear in person at Clarion University to verify his or her identity by presenting a valid governmentissued photo identification (ID), such as, but not limited to, a driver’s license, other state-issued ID, or passport. The
institution will maintain a copy of the student’s photo ID that is annotated by the institution with the date it was received
and reviewed and the name of the official at the institution authorized to collect the student’s ID.
In addition, the student must sign, in the presence of the institutional official, the following:

V5

Student’s Name: __________________________________________ Clarion ID: __________________________

Statement of Educational Purpose
I certify that I _____________________________ am the individual signing this Statement of Educational Purpose and
(Print Student’s Name)
that the federal student financial assistance I may receive will only be used for educational purposes and to pay the cost of
attending Clarion University for 2015-2016.
_________________________________________
(Student’s Signature)

_______________
(Date)

______________________
(Student’s ID Number)

OR
**To Be Signed With Notary (if the student is unable to appear in person at Clarion University to verify
his or her identity)
The student must provide:
(a) A copy of the valid government-issued photo identification (ID) that is acknowledged in the notary statement below,
such as but not limited to a driver’s license, other state-issued ID, or passport; and
(b) The original notarized Statement of Educational Purpose provided below.
Statement of Educational Purpose
I certify that I _____________________________ am the individual signing this Statement of Educational Purpose and
(Print Student’s Name)
that the federal student financial assistance I may receive will only be used for educational purposes and to pay the cost of
attending Clarion University for 2015-2016.
_________________________________________ _______________
(Student’s Signature)
(Date)
______________________
(Student’s ID Number)
Notary’s Certificate of Acknowledgement
State of _________________________________________________________________________________________
City/County of ___________________________________________________________________________________
On__________________________, before me, _________________________________________________________,
(Date)
(Notary’s name)
personally appeared, ____________________________________________, and provided to me on basis of satisfactory
(Printed name of signer)
evidence of identification _______________________________________ to be the above-named person who signed the
(Type of government-issued photo ID provided)
foregoing instrument.
WITNESS my hand and official seal
(seal)

_______________________________________________
(Notary signature)
My commission expires on _________________________
OVER

V5

G. Certification and Signatures
Each person signing this worksheet certifies that all of the
information reported on it is complete and correct.
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’s Signature

_________________________________
Date

_________________________________________________
Parent’s Signature

_________________________________
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.)

V5