The instructions and certifications below apply to each parent included in the household.
Complete this section if the parents will not file and are not required to file a 2017 income tax return with the IRS.
  • Neither parent was employed, and neither had income earned from work in 2017.
  • One or both parents were employed in 2017 and have listed below the names of all employers, the amount earned from each employer in 2017, and whether an IRS W-2 or an equivalent document is provided.
    [Provide copies of all 2017 IRS W-2 forms issued to the parents by their employers]. List every employer even if the employer did not issue an IRS W-2 form.

Parent 1's Employer Name
2017 Annual Amount Earned
Will provide IRS W-2?
Check box for Yes
Parent 1's Employer Name
2017 Annual Amount Earned
Will provide IRS W-2?
Check box for Yes
Parent 1's Employer Name
2017 Annual Amount Earned
Will provide IRS W-2?
Check box for Yes
Parent 1's Employer Name
2017 Annual Amount Earned
Will provide IRS W-2?
Check box for Yes
Parent 1's Employer Name
2017 Annual Amount Earned
Will provide IRS W-2?
Check box for Yes
Total Parent 1's Income $
Parent 2's Employer Name
2017 Annual Amount Earned
Will provide IRS W-2?
Check box for Yes
Parent 2's Employer Name
2017 Annual Amount Earned
Will provide IRS W-2?
Check box for Yes
Parent 2's Employer Name
2017 Annual Amount Earned
Will provide IRS W-2?
Check box for Yes
Parent 2's Employer Name
2017 Annual Amount Earned
Will provide IRS W-2?
Check box for Yes
Parent 2's Employer Name
2017 Annual Amount Earned
Will provide IRS W-2?
Check box for Yes
Total Parent 2's Income $

NOTE:

If more space is needed, provide a separate page with the student’s name and ID number at the top.

Request the verification of non-filing letter by accessing www.irs.gov and clicking on “Get Your Tax Record” or complete the IRS form 4506-T.
The 4506-T is available at https://www.irs.gov/pub/irs-pdf/f4506t.pdf. North Carolina residents may mail the form to Cincinnati, OH or fax to 855-800-8015.
Residents of other states should review page 2 of the form to determine where to mail or fax the form.

Provide documentation from the IRS or other relevant tax authority dated on or after October 1, 2018 that indicates a 2017 IRS income tax return was not filed with the IRS or other relevant tax authority.
  • Select here if confirmation of nonfiling is provided
  • Select here if confirmation of nonfiling will be provided later.

WARNING:

If you purposely give false or misleading information, you may be fined, sent to prison, or both.
Parent Email
Student Email
Student Signature
Student ID Number
Date
By checking this box, I ratify the use of my typed name and Student ID number as an electronic representation of my signature.
Parent Signature
Parent Signature Date
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