Fillable 18 19 Dep Verif Wksht Fillable (Cerritos College)

Fill Online, Printable, Fillable, Blank 18 19 Dep Verif Wksht Fillable (Cerritos College) Form

Use Fill to complete blank online CERRITOS COLLEGE pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

18 19 Dep Verif Wksht Fillable (Cerritos College)

On average this form takes 22 minutes to complete

The 18 19 Dep Verif Wksht Fillable (Cerritos College) form is 2 pages long and contains:

  • 0 signatures
  • 10 check-boxes
  • 82 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Cerritos College

BROWSE CERRITOS COLLEGE FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
2018–2019 Verification Worksheet
Dependent Student
A. Dependent Student’s Information
________________________________ _____________________________________ ___________________
Student’s Last Name Student’s First Name Student #
____________________________________________ _________________________________________
Student’s Email Address Student’s Phone Number (include area code)
B. Dependent Student’s Family Information
List below the people in your parent (s)’ household. Include yourself and your parent(s), (stepparent if applicable) even if you don’t live with your parent(s).
Include anyone who will receive more than half of their support from July 1, 2018, through June 30, 2019 from your parents. Include the name of the college
for any household member, who will be enrolled, at least half time in a degree, diploma, or certificate program at a postsecondary educational institution any
time between July 1, 2018, and June 30, 2019. Attach a separate page if needed.
Full Name
Age
Relationship
College
Will be Enrolled at
Least Half Time
Self
C. Dependent Student’s Income Information to Be Verified
Untaxed Income
I received sources of untaxed income in 2016. (Sources may include payments to tax-deferred pension/retirement savings,
child support received, housing, food, and other living allowances paid to members of the military, clergy, and others, veterans
non-education benefits, workers’ compensation, state disability, Black Lung benefits, untaxed portions of health savings
accounts, railroad retirement benefits, unemployment benefits, general relief, alimony, money received or paid on your behalf or
any other untaxed income received in 2016. Do not include social security benefits, Supplemental Security Income (SSI),
Workforce Investment Act (WIA) educational benefits, TANF, combat pay, benefits from flexible spending arrangements). I have
indicated the source and the amount below.
Sources of Untaxed Income (Student)
2016 Amount
Total
Filed a tax return
I used the IRS Data Retrieval Tool in FAFSA on the Web to retrieve and successfully transfer my 2016 IRS income information
into the FAFSA. Skip to Section D.
2016 IRS tax return transcript is attached. Please write your name and student number on transcript. Skip to Section D.
Did not file a tax return
I was not employed and had no income earned from work in 2016. I did not file 2016 taxes with the IRS and am not required to
file a 2016 income tax return.
I was employed in 2016, but am not required to file taxes. Listed below are the names of the employer and the amount earned.
W-2 forms are attached. I did not file 2016 taxes with the IRS and am not required to file a 2016 income tax return.
Employer’s Name (Student)
2016 Amount Earned
IRS W-2 Attached?
D. Parent’s Income Information to Be Verified
Untaxed Income
My parents received sources of untaxed income in 2016. (Sources may include payments to tax-deferred pension/retirement
savings, child support received, housing, food, and other living allowances paid to members of the military, clergy, and others,
veterans non-education benefits, workers’ compensation, state disability, Black Lung benefits, untaxed portions of health
savings accounts, and railroad retirement benefits, unemployment benefits, general relief, alimony, money received or paid on
your behalf or any other untaxed income received in 2016. Do not include social security benefits, TANF, combat pay, benefits
from flexible spending arrangements). I have indicated the source and the amount below.
Sources of Untaxed Income - Parent(s)
2016 Amount
Parent(s) filed a tax return
My parent(s) used the IRS Data Retrieval Tool in FAFSA on the Web to retrieve and successfully transfer their 2016 IRS income
information into the FAFSA. Skip to Section E.
2016 Parent(s) IRS tax return transcript is attached. Write the student’s name and student number on transcript. Skip to E.
Parent(s) did not file a tax return
My parent(s) was/were not employed and had no income earned from work in 2016. I did not file 2016 taxes with the IRS and
am not required to file a 2016 income tax return. Attached is the Verification of Non-Filing Letter from the Internal Revenue
Service (IRS).
My parent(s) was/were employed in 2016 and were not required to file a tax return. Listed below are the names of the employer
and the amount earned. W-2 forms are attached. I did not file 2016 taxes with the IRS and am not required to file a 2016
income tax return.
Employer’s Name - Parent(s)
2016 Amount Earned
IRS W-2 Attached?
E. Additional Information – Other Support Received
________________________________________________________________________________
________________________________________________________________________________
F. Certification and Signatures
Each person signing this worksheet certifies that all of the information reported is complete and correct. The
student and one parent must sign and date.
_________________________________________________ _________________________________
Student’s Signature Date
_________________________________________________ _________________________________
Parent’s Signature Date
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

18 19 Dep Verif Wksht Fillable (Cerritos College)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 20 July 2020

Message

View Audit Log
Print With Audit Log
Duplicate Document