Fillable 1011DVWS (Cerritos College)

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1011DVWS (Cerritos College)

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Country of origin: US
File type: PDF

U.S.A. forms for Cerritos College

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Your application was selected for review in a process called
“Verication.” In this process, your school will be comparing
information from your application with signed copies of your
and your parent(s)’ 2009 Federal tax forms, or with W-2 forms or
other nancial documents. The law says we have the right to ask
you for this information before awarding Federal aid. If there are
differences between your application information and your nan-
cial documents, you or your school may need to make corrections
electronically or by using your Student Aid Report (SAR).
Complete this verication form and submit it to your nancial aid
administrator as soon as possible, so that your nancial aid won’t
be delayed. Your nancial aid administrator will help you.
A. Student Information
B. Family Information
What you should do
1. Collect your and your parent(s)’ nancial documents (signed
Federal income tax forms, W-2 forms, etc.).
2. Talk to your nancial aid administrator if you have questions
about completing this worksheet.
3. Complete and sign the worksheet—you and at least one
parent.
4. Submit the completed worksheet, tax forms, and any other
documents your school requests to your nancial aid
administrator.
5. Your nancial aid administrator will compare information on
this worksheet and any supporting documents with the
information you submitted on your application. You or your
school may need to make corrections electronically or by
using your SAR.
Write the names of all household members in the space(s) below. Also write in the name of the college for any household member,
excluding your parent(s), who will be attending at least half time between July 1, 2010 and June 30, 2011, and will be enrolled in a
degree, diploma, or certicate program. If you need more space, attach a separate page.
List the people in your parent(s)’ household, including:
•yourself and your parent(s) (including stepparent) even if you don’t live with your parents, and
• your parents’ other children, even if they don’t live with your parent(s), if (a) your parents will provide more than half of their
support from July 1, 2010 through June 30, 2011, or (b) the children would be required to provide parental information when
applying for Federal Student Aid, and
• other people if they now live with your parents, and your parents provide more than half of their support and
will continue to provide more than half of their support from July 1, 2010 through June 30, 2011.
FORM APPROVED
OMB NO. 1845-0041
Missy Jones (example) 18 Sister Central University
Self
According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection
is 1845-0041. The time required to complete this information collection is estimated to average twelve minutes, including the time to review instructions, search existing data resources, gather the data needed, and complete and re-
view the information collection. If you have any comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: US Department of Education, Washington, DC 20202-5345.
2010-2011 Verication Worksheet
Federal Student Aid Programs
U.S. Department
of Education
Dependent
Last name First name M.I.
Address (include apt. no.)
City State ZIP Code
Social Security Number
Date of birth
Phone number (include area code)
Full Name Age Relationship College
Student ID #:
C. Student’s Tax Forms and Income Information (all applicants)
WARNING: If you purposely give false or misleading
information on this worksheet, you may be ned, be
sentenced to jail, or both.
Each person signing this form certies that all the information reported
on it is complete and correct. The student and at least one parent must
sign and date.
E. Sign this Worksheet
1. Check only one box below. Tax returns include the 2009 IRS Form 1040, 1040A, 1040EZ, a tax return from Puerto Rico or a
foreign income tax return. If your parent(s) did not keep a copy of their tax return, request a copy from the tax preparer or request
an Internal Revenue Service form that lists tax account information.
D. Parent(s)’ Tax Forms and Income Information
Check here if you are attaching a signed copy of your tax return.
Check here if a signed tax return will be submitted to the school by ______________________(date).
Check here if you will not le and are not required to le a 2009 U.S. Income Tax Return.
1. Check only one box below. Tax returns include the 2009 IRS Form 1040, 1040A, 1040EZ, a tax return from Puerto
Rico or a foreign income tax return. If you did not keep a copy of your tax return, request a copy from your tax preparer
or request an Internal Revenue Service form that lists tax account information.
3. If you did not le and are not required to le a 2009 Federal income tax return, list below your employer(s) and any
income received in 2009 (use the W-2 form or other earnings statements if available).
2. Funds received for child support and other untaxed income. (See Question 45 of the Free Application for
Federal Student Aid (FAFSA).)
Check here if you are attaching a signed copy of your parents’ tax return(s).
Check here if a signed tax return(s) will be submitted to the school by ______________________(date).
Check here if your parent(s) will not le and are not required to le a 2009 U.S. Income Tax Return.
3. If your parent(s) did not le and are not required to le a 2009 Federal income tax return, list below your parent(s)’
employer(s) and any income they received in 2009 (use the W-2 form or other earnings statements if available).
2. Funds received for child support and other untaxed income. (See Question 93 of the FAFSA.)
Dependent
a. Child Support
b. Workman’s Compensation
c. Untaxed Pensions
d.
e.
f.
$
$
$
$
$
$
Sources of Untaxed Income 2009 Amount Sources of Untaxed Income 2009 Amount
a. Child Support
b. Workman’s Compensation
c. Untaxed Pensions
d.
e.
f.
$
$
$
$
$
$
Sources of Untaxed Income 2009 Amount Sources of Untaxed Income 2009 Amount
Sources 2009 Income
$
$
$
Student Date
Do not mail this worksheet to the Department of Education. Submit this worksheet to your
Financial Aid Administrator at your school. Don’t forget to sign your tax forms.
Parent Date
$
$
$
Sources 2009 Income
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1011DVWS (Cerritos College)

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Completed 20 July 2020

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