Tulsa Community College

 Income Verification Form

TRIO Student Support Services

909 S Boston Ave
Tulsa , OK 74119
tulsacc.edu/trio
TRIOSSS@tulsacc.edu
918-595-8970
First Name *
Last Name: *
Date of Birth *
T Number: *

Please complete the Income Verification which is used to determine your program eligibility.

Verification requirements vary depending on whether you are an INDEPENDENT or DEPENDENT student, according to federal criteria which is available on the FAFSA website www.fafsa.gov

Per your TRIO SSS application and your determined dependency status be sure to provide information from the most recent tax year (2023):

If you are an Independent Student (typically age 24+, married, emancipated minor, veteran, or parent providing over half of child(ren)’s support) complete Part A and then provide your signature.

If you are a Dependent Student (typically younger than 24, unmarried); parent/guardian information is reported on FAFSA. Your parent/guardian must complete Part B and then provide their signature.

 Part A - Independent Students (Dependent Students skip to Part B)
Size of Family Unit:
2023 Taxable Income (IRS Form 1040 line 15)

OR
I did not file a tax return in 2023 because I was not required to file.

Part B - Dependent Students (Parent/guardian information)
Size of Family Unit:
2023 Taxable Income (IRS Form 1040 line 15)

OR
I/We did not file a tax return in 2023 because I was not required to file.

Sign and Submit:

By signing, I declare under penalty of perjury that the income verification information I have provided is true and correct to the best of my knowledge.

Independent Students complete with signature.

Dependent Students complete with a parent/guardian signature.

 
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