FinAid: Independent Student Non Taxfiler Verification Worksheet

Hidden Form Name
Office of Student Financial Aid
Division of Student Enrollment, Engagement & Services
2002 Rollins Hall ● Norfolk, VA 23529-0052 ● Telephone: (757) 683-3683 ● Fax: (757) 683-5920
Independent Student Non Taxfiler Verification Worksheet
The instructions and certifications below apply to each student and spouse, if the student is married.
Complete this section if the student and spouse will not file and are not required to file a income tax return with the IRS.
Aid Year *
Student Name Student Name * First Middle Last
Student UIN *
Must be 8 characters. Currently Entered: 0 characters.
Student Email *
Check the box that applies:
Section A:

Section A: The student was not employed and had no income earned from work in 2022. The student was employed in 2022 and has listed below all sources of income, the amount earned from each source, and whether an IRS W-2 form is attached. Attach copies of all 2022 forms issued to the student by employers. List every employer or source of income, even if they did not issue an IRS W-2 form.
Source of Income #1
2022 Amount Earned #1 $ Dollars . Cents
IRS W-2 Provided?

IRS W-2 Provided? Yes No
Source of Income #2
2022 Amount Earned #2 $ Dollars . Cents
IRS W-2 Provided?

IRS W-2 Provided? Yes No
Source of Income #4
2022 Amount Earned #3 $ Dollars . Cents
IRS W-2 Provided?

IRS W-2 Provided? Yes No
Source of Income #4
2022 Amount Earned #4 $ Dollars . Cents
IRS W-2 Provided?

IRS W-2 Provided? Yes No
Filers of non-IRS Tax Returns:

If a tax return was filed with another government of a foreign nation or a US territory or commonwealth, please submit a copy of the signed tax return or tax transcript.
Student and Spouse Income Documentation

If there is additional student or spouse income that could not be listed on this form, please record it on a separate sheet, scan, and upload ALL supporting income documentation in PDF format ONLY. If student and/or spouse were employed, W-2 statements MUST be provided.
Attach Files

Please include all supporting documentation for additional student and parent income that could not be captured on this form.
Section C:
Student: If no income was reported above I have indicated below how I supported myself in 2022. *
Certification and Signature

Each person signing below certifies that all information reported is complete and correct.
*WARNING: If you purposely give false or misleading information you may be fined, sentenced to jail, or both.
Student Signature *

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.
Date Date * / MM / DD YYYY
PLEASE ALLOW 3-4 WEEKS FOR PROCESSING/REVIEW. Old Dominion University is an equal opportunity, affirmative action institution. Minorities, women, veterans and individuals with disabilities are strongly encouraged to apply.

FinAid: Independent Student Non Taxfiler Verification Worksheet

Check the box that applies:

Filers of non-IRS Tax Returns: If a tax return was filed with another government of a foreign nation or a US territory or commonwealth, please submit a copy of the signed tax return or tax transcript.

Student and Spouse Income Documentation

Certification and Signature

PLEASE ALLOW 3-4 WEEKS FOR PROCESSING/REVIEW. Old Dominion University is an equal opportunity, affirmative action institution. Minorities, women, veterans and individuals with disabilities are strongly encouraged to apply.

Filers of non-IRS Tax Returns:

If a tax return was filed with another government of a foreign nation or a US territory or commonwealth, please submit a copy of the signed tax return or tax transcript.