Tusculum University-Knoxville-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). Please submit the tax return of the parent or guardian who claims the student as a dependent.

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. What is the dollar amount of your TAXABLE INCOME listed on your most recent tax return? (Taxable income is not “Wages, salaries, tips, etc” and is listed on a different line on your tax return).*
TAXABLE INCOME is line 11b on the 2019 income tax form. Taxable income is line 15 on the 2020 income tax form.
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 the ARCHES program at (865) 693-1177 ex. 5018 or arches@tusculum.edu.
If Dependent:
Parent's Signature

Clear
If Independent or Dependent:
Student's Signature*

Clear