Unformatted text preview: RS tax return filers, and up to
eight weeks for paper tax return filers. If the parents are married, and separate 2011 tax returns were filed, 2011
IRS tax return transcripts must be submitted for each parent.
Check here if an IRS tax return transcript(s) is attached to this worksheet. 2. TAX RETURN NONFILERS—Complete this section if the student’s parent(s) will not file and is not required to file a 2011
income tax return with the IRS.
Check the box that applies:
The parent(s) was not employed and had no income earned from work in 2011.
The parent(s) was employed in 2011 and has listed below the names of all the parent’s employers, the amount earned from
each employer in 2011, and whether an IRS W-2 form is attached. Attach copies of all 2011 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. If more space is needed, attach a
separate page with the student’s name and Social Security Number at the top.
Employer’s Name 2011 Amount Earned IRS W-2 Attached? E. Parent’s Other Information to Be Verified
1. Complete this section if someone in the student’s 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 2010 or 2011
One of the persons listed in Section B of this worksheet received SNAP benefits in 2010 or 2011.
• Please attach a copy of your SNAP benefits
2. Complete this section if one of the student’s parents paid child support in 2011.
One (or both) of the student’s parents listed in Section B of this worksheet paid child support in 2011. The parent has
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 2011 for each child. If asked by the school, 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 Social Security Number 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 Amount of Child
Support Paid in
2011 F. 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 _________________________________
Parent’s Signature _________________________________
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- Fall '11
- English, Taxation in the United States, Social Security number, IRS Tax Return