2014-2015 V6 Independent Verification Worksheet

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 our office 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 Finance Office. National Louis University may ask for additional information. If you have questions about verification, contact our office as soon as possible so that your financial aid will not be delayed.

Fields marked with an asterisk (*) are required fields

Independent Student's Information
First Name: *
Last Name: *
NLU ID Number: * (Example: N00123456)
Date of Birth: * / /
Address: *
City: *
State: *
Zip: *
Email: *
Phone Number: *
Alternate Phone Number:
Family Information

List the people in your household, including:

  • Yourself
  • Your spouse, if you are married
  • Your children if you will provide more than half of their support from July 1, 2014 through June 30, 2015 (even if they don't live with you)
  • Other people who live with you and you provide more than half of their support and will continue to from July 1, 2014 through June 30, 2015

List 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. Do not list any non-relative, extended family members, boyfriends, girlfriends, fiancés, or roommates unless they are claimed as a dependent on your (and, if married, your spouse's) taxes.

Full Name: Age: Relationship
to Student:
College: Will be Enrolled
at least Half-Time:
* *
Independent Student's Income Information to be Verified

If you are unable to use the IRS Data Retrieval Tool when submitting your FAFSA, you must submit a 2013 IRS Tax Return Transcript (not the original Income Tax Return) by contacting the IRS at 1-800-908-9946 or retrieving your transcript immediately at www.irs.gov/Individuals/Get-Transcript.

(Required to Check One)

Please attach here:

Date requested:
Student's Other Information to be Verified
        * Check here if anyone in the student's household (listed in Section B) received benefits from the Supplemental Nutrition Assistance Program (SNAP/formerly known as food stamps) any time during the 2012 or 2013 calendar years. (Note: If we have reason to believe that the information regarding the receipt of SNAP is inaccurate, we may require documentation from the agency that issued the SNAP benefits in 2012 or 2013).
        * Did you or your spouse pay child support in 2013?
Student's 2013 Untaxed Income

Please enter in the amounts below for yourself (and, if married, your spouse) which apply to you. Documentation may be requested.

        * Payments to tax-deferred pension and retirement savings plans (paid directly or withheld from earnings), including, but not limited to, amounts reported on the W-2 forms in Boxes 12a through 12d, codes D, E, F, G, H and S. Don’t include amounts reported in code DD (employer contributions toward employee health benefits).
        * List the actual amount of any child support received in 2013 for the children in your household. Don’t include foster care or adoption payments.
        * Housing, food and other living allowances paid to members of the military, clergy and others (including cash payments and cash value of benefits). Don’t include the value of on-base military housing or the value of a basic military allowance for housing.
        * Veterans non-education benefits, such as Disability, Death Pension, or Dependency & Indemnity Compensation (DIC) and/or VA Educational Work-Study allowances.
        * Other untaxed income not reported and not excluded on this form such as workers’ compensation, disability, etc. Also include the untaxed portions of health savings accounts from IRS Form 1040-line 25. Don't include extended foster care benefits, student aid, earned income credit, additional child tax credit, welfare payments, untaxed Social Security benefits, Supplemental Security Income, Workforce Investment Act educational benefits, on-base military housing or a military housing allowance, combat pay, benefits from flexible spending arrangements (e.g., cafeteria plans), foreign income exclusion or credit for federal tax on special fuels.
        * Money received, or paid on your behalf (e.g., payment of bills), not reported elsewhere on this form. This includes money that you received from anyone whose financial information is not reported on this form and that is not part of a legal child support agreement.
Certification and Signature
By printing my name below, I certify that all of the information reported on this worksheet 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 Signature: *
Spouse Signature (Optional):

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    122 S. Michigan Avenue
    Chicago, IL 60603
    (888) 658.8632
    Info » | Directions »

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    620 Tollgate Road
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    (888) 658.8632
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    5202 Old Orchard Road
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    (888) 658.8632
    Info » | Directions »

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    850 Warrenville Road
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    (888) 658.8632
    Info » | Directions »

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    (888) 658.8632
    Info » | Directions »

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    (800) 366.6581
    Info » | Directions »

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    12000 West Park Place, Suite 100
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    (414) 577.2658
    Info » | Directions »