STUDENT NAME:
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2024-2025 MASFA Independent Student Verification Form
MASSACHUSETTS OFFICE OF STUDENT FINANCIAL ASSISTANCE
Thank you for submitting your Massachusetts Application for State Financial Aid (MASFA). To complete your application
and be considered for need-based state financial aid, we need some additional information to confirm your financial
aid eligibility. Complete the form and submit the required documentation. Be sure to complete all sections of this
form, as incomplete forms will not be processed.
SECTION ONE: 2022 STUDENT INCOME AND TAX DATA
Select the box that applies to you (the student) and submit the required documentation.
□ I [and/or my spouse, if married] filed or will file a 2022 IRS income tax return.
Submit the following documentation: Signed copy of your 2022 Income Tax Return, including all file
d
s
chedules, as well as all 2022 wage statements (W-2 and/or 1099 forms)
□ I (and/or my spouse, if married) worked in 2022, but did not file or was not required to file a tax return.
Submit the following documentation: All 2022 W-2s or equivalent wage statements
.
In the chart below, list the names of all employers, the amount earned from each employer, and whether an IRS W-2 form
or an equivalent document was provided. List every employer even if the employer did not issue an IRS W-2 form.
□ I (and my spouse, if married) was not employed and had no income earned from work in 2022. I [and/or my
spouse, if married] did not file or was not required to file a 2022 IRS income tax return.
SECTION TWO: 2022 UNTAXED INCOME
Complete the chart below to provide additional information about untaxed income you may have received in 2022.
Do not leave any amount blank; if you did not receive a particular type of untaxed income, put “0” in the appropriate
box. Submit documentation of all untaxed income reported below.
Specify the source(s) of any “2022 Other Untaxed Income” reported here:
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
Employer’s Name Amount Earned in 2022
W-2 or an Equivalent
Document Provided?
(Example) ABC’s Auto Body Shop
$4,500
Yes
TOTAL AMOUNT OF INCOME EARNED FROM WORK IN 2022
$
Untaxed Income Type
2022 Amount
Child Support Received
$
Military or Clergy Allowances
Indicate total amount of any housing, food and other living allowances paid to members of the military, clergy and others
(including cash payments and cash value of benefits). Do not include the value of on-base military housing or the value of a basic
military allowance for housing.
$
Veterans Noneducation Benefits
Indicate any Veterans noneducation benefits, such as Disability, Death Pension, or Dependency & Indemnity Compensation (DIC)
and/or VA Educational Work-Study allowances
$
Other Untaxed Income
Examples include: workers’ compensation, disability benefits, untaxed foreign income, etc. Also include the untaxed portions of
health savings accounts from IRS Form 1040 Schedule 1- line 12. Do not include extended foster care benefits, student aid,
earned income credit, additional child tax credit, welfare payments, untaxed Social Security benefits, Supplemental Security
Income, Workforce Innovation and Opportunity Act educational benefits, on-base military housing or a military housing
allowance, combat pay, benefits from flexible spending arrangements (e.g., cafeteria plans), foreign income exclusion or credit
for federal tax on special fuels
$
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SECTION THREE: HOUSEHOLD INFORMATION
In the chart below, list the people in your household. Include the following people, if applicable:
Yourself.
Spouse, if you are married.
Your children, if any, if you will provide more than half of their support from July 1, 2024, through June 30,
2025, even if the child does not live with you.
Other people if they now live with you and you provide more than half of the other person’s support and will
continue to provide more than half of that person’s support through June 30, 2025.
If anyone in your household will be enrolled in college at least half-time any time between July 1, 2024 and
June 30, 2025, in a degree, diploma, or certificate program, please include the name of the
college/university they will be attending.
First and Last Name Age
Relationship
to You
Name of College
[if enrolled for 2024-2025]
write “N/A” if not applicable
Attending college
in 2024-2025 at
least half-time?
Self
If more space is needed, please provide a separate page with your name and date of birth at the top to include any
remaining household members.
SECTION FOUR: CERTIFICATIONS AND SIGNATURES
By signing below, I certify that all of the information reported on this form is complete and correct, and that any
incorrect or incomplete information may result in a change to or loss of my state financial aid eligibility.
_____________________________________________________ ________________________________
Print Student’s Name MASFA ID [OSFA Office Use Only]
_____________________________________________________ ________________________________
Student Email Address Phone Number
______________________________________________________ _________________
Student’s Signature (Required) Date
_____________________________________________________ __________________
Spouse’s Signature (Optional) Date
Submit completed form and all required documentation to our office in one of the following ways:
Fax: (617) 391-6085, attention of Stephannie Barboza
Mail:
Massachusetts Office of Student Financial Assistance
135 Santilli Highway
Everett, MA 02149
If you have any questions, please contact us at: MASFA@dhe.mass.edu
