Tusculum University-Greeneville-SSS-Income Verification

INCOME VERIFICATION FORM – Student Support Services
Name*

First NameLast Name
Email*
example@example.com
Please check one*

Dependent student (claimed by a parent or guardian on their taxes)Independent student (at least 24 years old by Dec. 31, orphan or ward of court at 18 years old, married, veteran or active duty military, have legal dependents, or homeless as a minor.
If Dependent, applicants must submit a copy of their parent's/guardian's most recent tax return (form 1040).

If Independent, applicants must submit a copy of their most recent tax return (form 1040).
Attach tax return here:

Cancelof
If you are unable to attach a tax return, you or your parents/guardians MUST answer the questions below.
1. What is your family size according to your most recent tax return (spouse plus dependents listed)?
2. Enter your taxable income as reported on the most recent income tax return. Taxable Income is LESS THAN your "adjusted gross income" and is listed further down on your tax return. Here is an example:
3. I did not file taxes last year for the following reason:

Social SecurityUnemploymentDisabilityVeteran’s BenefitsChild SupportOther
By completing this information, which will serve as a statement of income, you are certifying that the information furnished regarding the family size and taxable income is true to the best of your knowledge.

If you have any questions about how to complete this application, please contact Student Support Services at (423) 798-1635 or sss@tusculum.edu.
If Dependent:
Parent's Signature

Clear
If Independent or Dependent:
Student's Signature*

Clear