myUTSAID

Student's First Name:

Last:

2015-2016 Dependent Verification Form

Documentation submitted by fax or email will not be accepted. Fill out online and print.
Your application was selected for a process known as verification. UTSA will compare your Free Application for Federal Student
Aid (FAFSA) with both your and your parents' 2014 federal tax forms, per financial aid program rules (34 CFR, Section 668). If
differences arise between your FAFSA and your financial documents, we will correct and reprocess your application. Your
financial aid will not disburse until all documents are submitted and the verification process is complete.
For faster processing, it is recommended that you and your parents use the IRS Data Retrieval Tool (DRT) on your
FAFSA in lieu of submitting your signed tax returns or tax transcripts for 2014. You will then complete this worksheet,
sign it, and submit it to our office. If supplemental documentation is submitted (i.e. signed tax returns), please include
your name and ID on the top of each page.
STEP 1: Family Information
Write the names of all family or household members below. Also write in the name of the college for any family member
who will be attending college at least half-time between July 1, 2015 and June 30, 2016, and will be enrolled in a degree or
certificate program. If you need more space, attach a separate page.
Include people as part of your family or household below only if:
They lived with you and your parents and received more than half their support from you and your parents at
the time you completed your student aid application, AND
They will continue to receive more than half their support from July 1, 2015 through June 30, 2016.
Parents and step-parents that you live with must be included.
Full Name

Age

Relationship to Student

College Attending

Student/Self

UTSA

STEP 2: Income Information and/or Tax Forms (section A, B and C)

A. Indicate in the drop down box the tax filing status (did file or did not file) and inform us if you and your parents were
eligible to use the IRS DRT or will be attaching signed copies of 2014 tax returns.
Student*

Parent(s)*

*If you indicated did not file, skip the check

boxes below and proceed to section B.

Check if you and your parents updated your FAFSA using the IRS DRT in lieu of submitting copies of 2014 tax returns.
Check if you and your parents DID NOT use the IRS DRT on your FAFSA. Check your ASAP account to determine which
tax documents need to be submitted to our office.
**Continue Step 2 on next page**
Office Use Only

RRAAREQ Code: VERD16

Date: ______________ Received By: ______________ Processed By: ______________ . WebX Code: FA_VERIF_FORM
Page 1 of 2

One UTSA Circle | San Antonio, TX 78249 | 210-458-8000 | (800) 669-0919 | financialaid@utsa.edu

(Rev 03/04/15)

Student's First Name:

myUTSAID

B.

Regardless of whether or not you filed, list any income that was received from work in 2014.
(Do not leave any blanks; enter zero where applicable)
Employer Names

C.

Last:

Student Wages

Father/Stepfather Wages

Mother/Stepmother Wages

Tax filers and non-tax filers must list the following (taxed and untaxed) income received in 2014.
(Do not leave any blanks; enter zero where applicable)
2014 Additional Financial Information
Student Amount

Parent(s) Amount

Tax Deferred Pensions (W2 Box 12; Codes D, E, F, G, H, or S)

Child Support Received
VA Non-Education Benefits (Disability, Death Pension, DIC, VA WorkStudy)
Other Untaxed/Non-Reported Income
STEP 3: Certification Statement
Your signature on this document confirms your acknowledgement of the following:
The information submitted for review is true and correct to the best of your knowledge.
Providing false information may result in reduced eligibility, repayment of aid, or both.
During peak seasons, there may be a 7-10 business day processing time for the request.
Underestimating the projected income could result in reduced eligibility, repayment of aid, or both in this year or next.
You have read each section, provided the required documentation, and understand more may be required upon request.

Student Signature: ____________________________ Phone or Email:

Date:

Father/Stepfather Signature: ___________________ Mother/Stepmother Signature: __________________ Date:

With a few exceptions, you are entitled on your request to be informed about the information U.T. San Antonio collects about you. Under Sections 552.021 and 552.023 of
the Texas Government Code, you are entitled to receive and review this information. Under Section 559.004 of the Texas Government Code, you are entitled to have U.T.
San Antonio correct information about you that is held by us and that is incorrect, in accordance with the procedures set forth in the University of Texas System Business
Procedures Memorandum 32. The information that U.T. San Antonio collects will be retained and maintained as required by Texas records retention laws (Section 441.180
et seq.of the Texas Government code) and rules. Different types of information are kept for different periods of time.

Office Use Only

RRAAREQ Code: VERD16

Date: ______________ Received By: ______________ Processed By: ______________ . WebX Code: FA_VERIF_FORM
Page 2 of 2

One UTSA Circle | San Antonio, TX 78249 | 210-458-8000 | (800) 669-0919 | financialaid@utsa.edu

(Rev 03/04/15)