Maryland Higher Education Commission

Office of Student Financial Aid DEPENDENT STUDENT

6 N. Liberty Street, Ground Suite
Baltimore, MD 21201
Verification Worksheet
(410) 767-3300; (800) 974-0203 Guaranteed Access Grant
TTY for the Deaf - (800) 735-2258
MHEC.MARYLAND.GOV 2018-2019 Academic Year

RETURN THIS FORM AND REQUIRED DOCUMENTATION BY APRIL 1, 2018.

PLEASE CHECK THE FOLLOWING:
 ALL information on this Verification Worksheet has been completed (INCLUDING Section C, Question 4 whereby all
numeric values have been entered).
 ONLY IF TAXES WERE FILED, my and/or my spouse’s 2016 IRS Tax Return Transcript is attached. (Transcript must be
requested from the IRS: http://www.irs.gov/individuals/get-transcript. If the IRS Data Retrieval Tool was used when filing the
FAFSA the Tax Return Transcript is not required for submission unless specifically requested).
 Photocopies of ALL documents (i.e. 2016 W-2(s), or other earning statement(s) or 2016 IRS Schedule C form(s) are attached as
applicable).
 ALL documents included must have the student’s MHEC ID number (MHEC number can be accessed online through the
students MDCAPS portal)

MAIL ALL DOCUMENTS ALONG WITH THIS FORM TO:

Maryland Higher Education Commission
Office of Student Financial Assistance
Attention: GA Grant Verification
6 N. Liberty Street, Ground Suite
Baltimore, MD 21201

 REMINDER: If the financial information on your FAFSA differs from the information in the financial documents submitted for
this verification process, your eligibility may be affected.

SECTION A: STUDENT INFORMATION (PLEASE PRINT)

Last name: ______________________________________________ First name: __________________________________ MI: ______

Social Security Number: _____________ - ___________ - ___________Date of birth: _______ /_______ /________ (MM/DD/YY)
Home telephone number: (________) ________ - ________ E-mail:______________________________________________________
Street Address: _________________________________________________________________________________________________
City: _______________________________________________________ State: ________________ Zip code: ____________________
Complete name of the institution you will attend during the 2018-2019 academic year:_________________________________________

SECTION B: FAMILY INFORMATION (PLEASE PRINT)

FULL NAME of ALL family members (INCLUDING those AGE RELATIONSHIP NAME of COLLEGE ATTENDING IN
receiving at least 50% of support from you) * 2018-2019

SELF

LIST THE PEOPLE IN YOUR HOUSEHOLD, INCLUDING YOURSELF:

(OVER)
 SECTION C: TAX FORMS AND INCOME INFORMATION
PLEASE NOTE: The Maryland Higher Education Commission encourages students and families to use the IRS Data
Retrieval Tool when filing the FAFSA. If the IRS Data Retrieval Tool is used, the Tax Return Transcript(s) are not required
for the Verification Process, unless specifically requested. Federal Tax Return Transcript(s) are provided by the U.S. Internal
Revenue Service by telephone request at 1-800-908-9946, by written request using IRS Form 4506T-EZ, or by online request
at: http://www.irs.gov/individuals/get-transcript.
CHECK ONE BOX ONLY IN EACH APPLICIBLE QUESTION:
1. STUDENT’S TAX INFORMATION: CHECK ONE BOX ONLY:
 I have completed my 2016 Federal Income Tax form. [Required Documents: Attach 2016 IRS Tax Return Transcript and
2016 W-2(s), or other earning statement(s) or 2016 IRS Schedule C form(s)]
 I have completed my 2016 Federal Income Tax form and used the IRS Data Retrieval Tool (DRT) and therefore not required to
a copy of the IRS Tax Transcript unless otherwise requested from the Maryland Higher Education Commission.
 I am not going to file/have not filed my 2016 Federal Income Tax form because I am not required to file. [Required
Documents if applicable: Attach 2016 W-2(s), or other earning statement(s) or 2016 IRS Schedule C form(s) from
employment held during 2016]
2. PARENT’S TAX INFORMATION: CHECK ONE BOX ONLY:
 I have completed my 2016 Federal Income Tax form. [Required Documents: Attach 2016 IRS Tax Return Transcript and
2016 W-2(s), or other earning statement(s) or 2016 IRS Schedule C form(s)]
 I have completed my 2016 Federal Income Tax form and used the IRS Data Retrieval Tool (DRT) and therefore not required to
a copy of the IRS Tax Transcript unless otherwise requested from the Maryland Higher Education Commission.
 I am not going to file/have not filed my 2016 Federal Income Tax form because I am not required to file. [Required
Documents if applicable: Attach 2016 W-2(s), or other earning statement(s) or 2016 IRS Schedule C form(s) from
employment held during 2016]
3. DISCLOSURE OF INCOME FOR NON-FILERS OF TAX RETURNS:
If you did not file and are not required to file a 2016 Federal Income Tax return, list below your employer(s) and any income
received in 2016. [Required Documents if applicable: 2016 W-2 form(s) or other earnings statement(s), or 2016 Schedule C(s)
from employment held during 2016.]
Employer 2016 Income Amount for Student 2016 Income Amount for Parent

4. VERIFICATION OF UNTAXED INCOME: (SEE QUESTIONS 45 AND 94 ON THE FAFSA) CIRCLE YES OR NO YES or NO
ANY BLANK LINE BELOW MUST HAVE A NUMERIC VALUE INSERTED
EXAMPLE:
Did YOU receive Child Support in 2016? YES NO If YES, enter the annual amount: $ 6600
Did YOU receive Cash Support in 2016? YES NO If YES, enter the annual amount: $ 0____
Did YOU receive Child Support in 2016? YES NO If YES, enter the annual amount: $ _________
Did YOU receive Cash Support in 2016? YES NO If YES, enter the annual amount: $ _________
Did YOU make payments to pension/savings plan in 2016? YES NO If YES, enter the annual amount: $ _________
Did YOU receive Other Untaxed Income in 2016? YES NO If YES, enter the annual amount: $ _________
Did YOU receive Additional Other Untaxed Income in 2016? YES NO If YES, enter the annual amount: $ _________
Did YOUR PARENT receive Child Support in 2016? YES NO If YES, enter the annual amount: $ _________
Did YOUR PARENT receive Cash Support in 2016? YES NO If YES, enter the annual amount: $ _________
Did YOUR PARENT make payments to pension/savings plan in 2016? YES NO If YES, enter the annual amount: $ _________
Did YOUR PARENT receive Other Untaxed Income in 2016? YES NO If YES, enter the annual amount: $ _________
Did YOUR PARENT receive Additional Other Untaxed Income in 2016? YES NO If YES, enter the annual amount: $ _________
Acceptable documentation for Child Support includes a photocopy of a court order; separation agreement; etc. that disclosed the amount

SECTION D: SIGN THIS WORKSHEET

By signing this worksheet, I/we certify that all the information reported on it is complete and correct. (Both you AND your parent must sign)
_______________________________________________________________ _____________________________________________
Student Date

_______________________________________________________________ _____________________________________________
Parent Date

This form and all required documents must be received at MHEC by April 1, 2018
Under provisions of the American with Disabilities Act, this material is available in alternate formats. Please call (410) 767-3300, (800) 974-0203, or (800) 735-2258 (TTY/Voice). 10/01/2017