2016-2017 Verification Worksheet- V6 DIRECTIONS

Your application was selected by the U.S. Dept. of Education for review in a process called "verification". You must submit the last 5 pages of this verification worksheet, provide IRS Income Verification, and W2s. IRS Income Verification for tax filers can be obtained in two different ways: Option 1 - IRS Data Retrieval process through FAFSA (which is the quickest way to get your IRS Income Verification to us) or Option 2 - Tax Transcript through the IRS. Because of this difference in processing time, we strongly recommend utilizing the IRS Data Retrieval (Option 1). o Please note recently widowed, separated, married filed separately, or divorced parents that were required to file a joint return are NOT eligible to do the IRS Data Retrieval. In this case you will need to follow Option 2. o For families with special circumstances, such as filing tax extensions (Form 4868), victims of identity theft, amended tax return filers (1040X), please see the section on special circumstances below.

Option 1 – IRS DATA RETRIEVAL INTO FAFSA: The most efficient way to verify income is by using the IRS Data Retrieval Tool within your FAFSA application. If the student/parent has not already used the tool, go to FAFSA.gov, log in to the student’s FAFSA record, select “Make FAFSA Corrections,” and navigate to the Financial Information section of the form. From there, follow the instructions to determine if the student/parent is eligible to use the IRS Data Retrieval Tool to transfer 2015 IRS income tax information into the student’s FAFSA. Once the IRS data transfer is complete, electronically SIGN and SUBMIT your FAFSA. It takes up to two weeks for IRS income information to be available for the IRS Data Retrieval Tool for electronic IRS tax return filers, and up to eight weeks for paper IRS tax return filers.

Option 2 - IRS TAX RETURN TRANSCRIPT: If you do not or cannot use the IRS Data Retrieval tool, all tax filers must submit a 2015 IRS Tax Return Transcript. You can obtain a Tax Return Transcript by using one of the following: • Online Request - Go to www.IRS.gov, under the Tools heading on the IRS homepage, click "Get Transcript by Mail." Make sure to request the “IRS Tax Return Transcript” and NOT the “IRS Tax Account Transcript.” • IRS2Go App – download the app at the following to request a transcript: Apple Online Store at https://itunes.apple.com/us/app/irs2go/id414113282?mt=8 Google Play at https://play.google.com/store/apps/details?id=gov.irs • Telephone Request - 1-800-908-9946 • Paper Request Form - IRS Form 4506T-EZ or IRS Form 4506-T on www.irs.gov.

SPECIAL CIRCUMSTANCES: • Tax Extension o Form 4868 that was filed with the IRS for the tax year o Copy of the IRS approval of the extension beyond the 6 month extension (if applicable) o W-2 Form(s) in 2015 or if self-employed, a signed statement certifying the 2015 AGI and tax paid. • Identity Theft o Tax Return Database View (TRDV) Transcript obtained from the IRS by calling 1-800-908-4490. o Statement signed and dated by the tax filer indicating that they were victims of IRS Taxrelated identity theft and that the IRS has been made of aware of the tax-related identity theft.

• Amended Returns o IRS Form 1040X (signed) o IRS Tax Return Transcript that includes information from the original OR any other IRS Transcript that includes all income and tax information from the original tax return required for verification. • Foreign Tax Returns/Puerto Rico, Northern Mariana Islands, Guam, American Samoa, or U.S. Virgin Islands Tax Returns o Transcript from relevant taxing authority listing tax account information for the tax year, if transcript can be obtained at no cost. Otherwise, a copy of tax return filed with taxing authority.

2016-2017 Verification Worksheet- V6

A. STUDENT VERIFICATION: ______________________________________________________________ Student’s Last Name Student’s First Name Student’s M.I.

_______________________________________ Student’s ID Number

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

_______________________________________ Student’s Date of Birth

______________________________________________________________ City State Zip Code

_______________________________________ Student’s Email Address

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

_______________________________________ Student’s Alternate or Cell Phone Number

B. FAMILY HOUSEHOLD VERIFICATION: If you are a dependent student: • Include yourself. • Include your parent(s): o If your parents are divorced, list the parent you lived with the most during the last 12 months. If you did not live with one parent more than the other, indicate the parent who provided more than half of your support during the last twelve months. o If your parent is remarried, include step-parent. o If your parents are unmarried but live together, list Parent #1 and Parent #2. • Include any other children of your parent(s), if your parents provide more than half of their support between July 1, 2016 and June 30, 2017 or if the children would be required to provide parental information if they were completing a 2016-17 FAFSA. • Include other dependents, if they now live with your parent(s) and your parent(s) will continue to provide more than half of their support through June 30, 2017.

Full Name

Age

Relationship Self

If you are an independent student: • Include yourself. • Include your spouse, if you are married. • Include your children or your spouse’s children if you or your spouse will provide more than half of their support between July 1, 2016 and June 30, 2017, even if the children do not live with you. • Include other dependents, if they now live with you and you or your spouse will continue to provide more than half of their support through June 30, 2017. Full Name: Write first and last name of household member. Age: Write the age of each family member in the chart below. Relationship: Write the Relationship of each family member to the student in the chart below. College: Add the name of the college for any household member who will be enrolled in a degree, diploma, or certificate program at an eligible postsecondary educational institution at least half-time any time between July 1, 2016 and June 30, 2017, excluding your parents. College attending in 16-17 Sacred Heart University

Will be Enrolled at Least Half Time (Yes or No)

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2016-2017 Verification Worksheet- V6 C. INCOME VERIFICATION: TAX RETURN FILERS - Attach a copy of a Federal Tax Transcript from the IRS or retrieve via FAFSA (IRS Data Retrieval). You must list any untaxed income from 2015 below. Enter zeros if no funds were received. NON-FILERS - Complete this section below if the student/parent will not file and is not required to file a 2015 income tax return with the IRS. List below source(s) and ALL income received in 2015 (attach your W-2 forms or other documents). If student or parent earned cash only, no W-2 form is required (however indicate cash then). Use another worksheet if needed. Check the box(es) for those people who did not and are not required to file a 2015 Federal Tax Return. Please attach your W-2 forms or other documents if you did not file a tax return. You Source of Income/Support

Your Father

Student Amount

Your Mother

Father Amount

Mother Amount

$

$

$

$

$

$

$

$

$

D. SNAP BENEFITS VERIFICATION: Supplemental Nutrition Assistance Program (SNAP) - formerly food stamps. Were you or members of your household eligible to receive food stamps sometime during 2014 or 2015?

Check all boxes that apply: The student received food stamps in 2014 or 2015

Amount received: $_______________

Your parent(s) received food stamps in 2014 or 2015

Amount received: $_______________

The student did not receive food stamps in 2014 or 2015

Your parent(s) did not receive food stamps in 2014 or 2015

E. CHILD SUPPORT PAID VERIFICATION: Did you or a member of your household pay child support during 2015? (Do not include support for children included in household size in Family Household Verification on page 1) My parent(s) paid child support during 2015 I (or my spouse, if married) paid child support during 2015 Neither I nor my parent(s) paid child support in 2015

Name of Person Who Paid Child Support

Name of Person to Whom Child Support was Paid

Marty Jones

Chris Smith (example)

Name of Child for Whom Support Was Paid Terry Jones

Amount of Child Support Paid in 2015 $6,000.00

Age of Child to Whom Child Support Was Paid in 2015 10

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2016-2017 Verification Worksheet- V6 F. OTHER UNTAXED INCOME VERIFICATION: 1. Payments to tax-deferred pension and retirement savings List any payments (direct or withheld from earnings) to tax-deferred pension and retirement savings plans (e.g., 401(k) or 403(b) plans), including, but not limited to, amounts reported on W-2 forms in Boxes 12a through 12d with codes D, E, F, G, H, and S. (attach your W-2 forms or other documents). Name of Person Who Made the Payment

Total Amount Paid in 2015

2. Child support received List the actual amount of any child support received in 2015 for the children in your household. Do not include foster care payments, adoption payments, or any amount that was court-ordered but not actually paid. Name of Adult Who Received the Support

Name of Child for Whom Support was Received

Amount of Child Support Received in 2015

3. Housing, food, and other living allowances paid to members of the military, clergy, and others Include cash payments and/or the cash value of benefits received. Do not include the value of on-base military housing or the value of a basic military allowance for housing. Name of Recipient

Type of Benefit Received

Amount of Benefit Received in 2015

4. Veterans non-education benefits List the total amount of veterans non-education benefits received in 2015. Include Disability, Death Pension, Dependency and Indemnity Compensation (DIC), and/or VA Educational Work-Study allowances. Do not include federal veteran’s educational benefits such as: Montgomery GI Bill, Dependents Education Assistance Program, VEAP Benefits, Post-9/11 GI Bill. Name of Recipient

Type of Veterans Non-education Benefit

Amount of Benefit Received in 2015

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2016-2017 Verification Worksheet- V6 5. Additional untaxed income List the amount of other untaxed income not reported and not excluded elsewhere on this form. Include untaxed income such as workers’ compensation, disability, Black Lung Benefits, untaxed portions of health savings accounts from IRS Form 1040 Line 25, Railroad Retirement Benefits, etc. Do not include any items reported or excluded in A-D above. In addition, do not include student aid, Earned Income Credit, Additional Child Tax Credit, Temporary Assistance to Needy Families (TANF), untaxed Social Security Benefits, Supplementary Security Income (SSI), Workforce Investment Act (WIA), educational benefits, combat pay, benefits from flexible spending arrangements (e.g., cafeteria plans), foreign income exclusion, or credit for federal tax on special fuels. Name of Recipient

Type of Other Untaxed Income

Amount of Other Untaxed Income Received in 2015

6. Money received or paid on the student’s behalf List any money received or paid on the student’s behalf (e.g., payment of student’s bills) and not reported elsewhere on this form. Enter the total amount of cash support the student received in 2015. Include support from a parent whose information was not reported on the student’s 2016-2017 FAFSA, but do not include support from a parent whose information was reported. For example, if someone is paying rent, utility bills, etc., for the student or gives cash, gift cards, etc., include the amount of that person’s contributions unless the person is the student’s parent whose information is reported on the student’s 2016-2017 FAFSA. Amounts paid on the student’s behalf also include any distributions to the student from a 529 plan owned by someone other than the student or the student’s parents, such as grandparents, aunts, and uncles of the student. Purpose: e.g., Cash, Rent, Books

Amount Received in 2015

Source

Additional Information: So that we can fully understand the student’s family’s financial situation, please provide below information about any other resources, benefits, and other amounts received by the student and any members of the student’s household. This may include items that were not required to be reported on the FAFSA or other forms submitted to the financial aid office, and include such things as federal veterans education benefits, military housing, SNAP, TANF, etc. Name of Recipient

Type of Financial Support

Amount of Financial Support Received in 2015

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2016-2017 Verification Worksheet- V6 G. CERTIFICATION AND SIGNATURES VERIFICATION: 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.

Note: if any information on this form is left blank it will be considered zero or not applicable.

_________________________________________________ Student’s Signature

_________________________________ Date

_________________________________________________ Parent’s or Spouse’s Signature

_________________________________ Date

If there are differences between your application and the documents you've submitted, corrections may be needed. We cannot process your federal aid until verification has been completed. Please provide the required documentation within 15 days of starting school or the start of your next academic year as applicable.

Please submit pages 1-5 of this Verification Worksheet, along with your Tax Transcripts and W2s (if applicable) to: Office of Student Financial Assistance, 5151 Park Avenue, Fairfield, CT 06825 P: 203-371-7980 F: 203-365-7608 Email: [email protected]

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