Financial Aid Office
1200 16th Street
Golden CO 80401
303-273-3301
303-384-2252 fax
finaid@mines.edu

Verification of 2015 Income Information for Student Nontax Filers

Student: ____________________________________ CWID:____________________


You (and/or your spouse) will not file a federal tax return, are not required by the IRS to file, and were
not employed in 2015/had no income earned from work.


You (and/or your spouse) will not file a federal tax return, are not required by the IRS to file, and were
employed in 2015, submit:
 Completed table (below) listing all employers and amount earned
 W-2s or 1099s for every employer listed. If no document is available, please explain. You must
list all employers even if they did not provide a document.

Note: If you were issued a 1099 or were not issued any income documentation from your employer, you may be
required to file a 2015 Federal Income Tax Return. If you earned more than $400 in untaxed income, please
complete an IRS form Schedule C. If net profit from line 31 of the schedule C is more than $400, you will be required
to file taxes. If you are not required to file taxes, submit a completed IRS form Schedule C and sign and date the
bottom of the form.

Employer’s Name
2015 Amount
IRS W-2 Provided? If not, please explain.
Earned
Al’s Auto Body Shop (example)
$2,000.00
Yes














By signing below, I (we) certify that all 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____________________________________

Date___________

Spouse (if married) ___________________________

Date___________