Fillable 1920V5 Dependent Verification Wksht (Solano Community College)

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1920V5 Dependent Verification Wksht (Solano Community College)

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Office of Financial Aid
2019-2020
DEPENDENT AGGREGATE
VERIFICATION FORM
V5D_20 Rev. 3/14/19
Your 2019-2020 Free Application for Federal Student Aid (FAFSA) was selected for review in a process called verification. The law
requires that before awarding federal student aid, the SCC Financial Aid Office must ask you to confirm the information you and/or your
parents reported on your FAFSA. To verify that you provided correct information, we will compare your FAFSA application with the
information on this worksheet and any other required documents. If there is conflicting information, your FAFSA application may need to
be corrected. You and at least one parent must complete and sign this worksheet, attach any required documents, and submit the form(s)
to the SCC Financial Aid Office. We may ask for additional documentation. If you have questions about verification, please contact the
Financial Aid Office as soon as possible so your financial aid will not be delayed.
A. Student Information (Please complete using blue/black ink)
______________________________________________________________ ___________________________________
Last Name First Name M.I. SCC ID Number
______________________________________________________________ ___________________________________
Address (include apt. no.) E-mail Address
______________________________________________________________ ___________________________________
City State Zip Code Phone Number
B. Dependent Student’s Family Information
List below the people in your parent(s)’ household. Include:
Yourself and your parent(s) (including a stepparent) even if you don’t live with your parent(s).
Your parent(s)’ other children if your parent(s) will provide more than half of their support from July 1, 2019,
through June 30, 2020, or if the other children would be required to provide parental information if they were
completing a FAFSA/California Dream Application for 2019–2020. Include children who meet either of
these standards, even if they do not live with your parent(s).
Other people if they now live with your parent(s) and your parent(s) provide more than half of their support
and will continue to provide more than half of their support through June 30, 2020.
Include the name of the college for any household member, excluding your parent(s), 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, 2019, and June 30, 2020. If more space is needed, attach a separate page with the student’s name
and Student ID number at the top.
Full Name
Age
Relationship
College
Will be Enrolled at
Least Half Time
Missy Jones (example)
18
Sister
Central University
Yes
Self Solano Community College
V5D_20 Rev. 3/14/19
Student’s Name: ___________________________________________ SCCID#: ____________________________
C. Student’s 2017 Income Information To Be Verified – Fill Out Appropriate Section:
D. Parent’s Income Information To Be Verified – Fill Out Appropriate Section:
Note: If two parents were reported in Section B of this worksheet, the instructions and certifications below refer and apply
to both parents
2017 IRS tax return, the student must contact the financial aid
administrator before completing this section.
Instructions: Complete this section if the student filed or will
file a 2017 IRS income tax return. The best way to verify
income is by using the IRS Data Retrieval Tool (IRS DRT) on
FAFSA on the Web at FAFSA.gov. In most cases, no further
documentation is needed to verify 2017 income information
that was transferred into the student’s FAFSA using the IRS
DRT if that information was not changed by the FAFSA filer.
Check the box that applies:
The student has used the IRS Data Retrieval Tool in
FAFSA on the Web to retrieve and transfer 2017 IRS
income information into the student’s FAFSA, either
on the initial FAFSA or when making a correction to
the FAFSA (does not apply to Dream Act Applicants).
The student is unable or chooses not to use the IRS
Data Retrieval Tool and the student’s 2017 IRS tax
return transcript is attached.
The student is unable or chooses not to use the IRS
Data Retrieval Tool and a Signed & Dated copy of
all pages of the student’s 2017 IRS federal income
Student Tax Return Filers
Student Non-Tax Filers
Instructions: Complete this section and attach ALL 2017
W-2(s) or 2017 Wage & Income Transcript if necessary, if the
student will not file and is not required to file a 2017 income
tax return with the IRS.
Check the box that applies:
The student was not employed and had no income
earned from work in 2017.
The student was employed in 2017 and has listed
below the names of all the student’s employers, the
amount earned from each employer in 2017. List every
employer even if they did not issue an IRS W-2 form.
Employers Name
2017 Amount
Earned
Suzy’s Auto Body Shop (example)
$2,000
Important Note: If the student’s parent(s) filed, or will file, an
amended 2017 IRS tax return, please contact the financial aid
administrator before completing this section.
Instructions: Complete this section if the student’s parent(s)
filed or will file a 2017 IRS income tax return. The best way to
verify income is by using the IRS Data Retrieval Tool (IRS DRT)
on FAFSA on the Web at FAFSA.gov. In most cases, no further
documentation is needed to verify 2017 income information that
was transferred into the student’s FAFSA using the IRS DRT if
that information was not changed by the FAFSA filer.
Check the box that applies:
The student’s parent(s) has used the IRS Data
Retrieval Tool in FAFSA on the Web to retrieve and
transfer 2017 IRS income information into the student’s
FAFSA, either on the initial FAFSA or when making a
correction to the FAFSA (Does not apply to Dream Act
Applicants).
The student’s parent(s) were unable or chooses not to
use the IRS Data Retrieval Tool on the FAFSA and the
student’s parent(s)’ 2017 IRS tax return transcript is
attached.
The student’s parent(s) were unable or chooses not to
use the IRS Data Retrieval Tool and Signed & Dated
copies of all pages of the parent(s) 2017 IRS federal
income tax return are attached.
Instructions: Complete this section and attach ALL 2017
W-2(s) or 2017 Wage & Income Transcript(s) if necessary. If
the student’s parent(s) will not file and is not required to file a
2017 income tax return with the IRS, the student’s parent(s)
MUST provide a 2017 “Verification of Non-filing Letter” from
the IRS.
Check the box that applies:
The student’s parent(s) was not employed and had no
income earned from work in 2017.
The student’s parent(s) was employed in 2017 and has
listed below the names of all the student’s parent(s)
employers, the amount earned from each employer in
2017. List every employer even if they did not issue an
IRS W-2 form.
Employers Name
2017 Amount
Earned
Suzy’s Auto Body Shop (example)
$2,000
Parent Tax Return Filers
Parent Non-Tax Filers
V5D_20 Rev. 3/14/19
Student’s Name: ___________________________________________ SCCID#: ____________________________
E. Student’s High School Completion Status
Provide one of the following documents as proof of your high school completion status for when you begin college in 2019-
2020:
I have a high school diploma
A copy of my high school diploma is attached
A copy of my final, official high school transcript is attached (must include date of
graduation)
I have a GED
A copy of my GED Certificate is attached
A copy of my GED transcripts are attached
I received a State Certificate
A copy of my state-recognized high school equivalent certificate is attached
I was home schooled
A copy of California home school academic transcript is attached (must be signed by the
parent or guardian of the home school)
A copy of my home school credential is attached (if home schooled outside the state of
California)
I have a foreign high school diploma
A copy of my “secondary school leaving certificate” or similar government document is
attached
None of the above
An academic transcript showing successful completion of a two-year college program is
attached (must be acceptable for full credit toward a bachelor’s degree)
A copy on my Ability-to-Benefit (ATB) test with a passing score is attached (must be
dated prior to July 1, 2012)
An official college transcript with at least 6 completed credit hours toward a degree or
certificate is attached (must have been earned prior to July 1, 2012)
F1. Statement of Educational Purpose and Identity Verification
Instructions: Check one of the boxes below. If unable to appear in person at the Solano
Community College, please check the second box and read additional instructions below.
I am appearing in person with my valid government-issued photo ID (driver’s license, state identification card, or
passport). Sign Statement of Educational Purpose on the next page then continue to page 4 section G.
I am unable to appear in person and have attached a notarized copy of this form AND a copy of my valid
government-issued photo ID (driver’s license, state identification card, or passport). Sign the Statement of
Educational Purpose then continue to section F2.
Office Use Only:
Made ID Copy Date Stamped Staff Initials: _________
V5D_20 Rev. 3/14/19
Notary Signature
Date
Type of government issued ID provided
Notary Seal
PLEASE NOTE: Notary section is for students who cannot
appear in person. Faxed copies will NOT be accepted
Notary’s Name
Printed Name of Signer
Date
City or County
State
Student’s Name: ___________________________________________ SCCID#: ____________________________
Identity and Statement of Educational Purpose
(To be signed at the institution OR in the presence of a Notary)
The student must appear in person at Solano Community College to verify his or her identity by presenting an unexpired
valid government-issued photo ID such as a driver’s license, other state-issued ID, or passport. The institution will maintain
a copy of the student’s photo ID that is annotated by the institution with the date it was received and reviewed, and the
name of the official at the institution authorized to receive and review the student’s ID.
In addition, the student must sign, in the presence of the institutional official, the Statement of Educational Purpose
provided below.
Statement of Educational Purpose
I certify that I _________________________________________________________ am the individual signing this
Statement of Educational Purpose and that the Federal Student Financial Assistance I may receive will only be used for
educational purposes and to pay the cost of attending Solano Community College for 2019-2020.
_________________________________________ _______________ ____________________________
Student Signature Date SCC ID Number
F2. Notary’s Certificate of Acknowledgement (complete only if unable to appear in person)
NOTE: If the student is unable to appear in person at Solano Community College to verify his or her identity, the
student must provide to the institution:
a) A copy of the unexpired valid government-issued photo identification (ID) that is acknowledged in the notary
statement on page 2, or that is presented to a notary, such as, but not limited to, a driver’s license, other state-issued
ID, or passport; AND
b)
The original Statement of Educational Purpose on page 2, which must be notarized. If the notary statement appears on
a separate page than the Statement of Educational Purpose, there must be a clear indication that the Statement of
Educational Purpose was the document notarized.
State of ____________________________________________ City/County of ___________________________________
On ___________________, before me, _________________________________________________________ personally
Appeared, _______________________________________, and proved to me on basis of satisfactory evidence of
identification _______________________________________________ to be the above-named person who signed the
forgoing instrument. WITNESS my hand and official seal
_______
_________________________________
My commission expires on _________________.
V5D_20 Rev. 3/14/19
WARNING: Purposely
giving false or misleading
information on this
worksheet may result in
fines and/or jail time.
Student’s Name: ___________________________________________ SCCID#: ____________________________
E. Certification and Signatures
Each person signing this worksheet certifies that all of the information reported on it is complete and correct. The student
and one parent must sign and date.
___________________________________________ _______________
Student’s Signature Date
___________________________________________ _______________
Parent’s Signature Date
Originals must be submitted, faxed copies will NOT be accepted.
Financial Aid Verification Frequently Asked Questions
What if my parent(s) or I…
Please
Amended the Tax Return for 2017?
• A Tax Return Transcript AND
• A signed copy of the IRS 1040X that was filed
Filed a Tax Return extension
for 2017?
• A copy of IRS form 4868 that was filed with the IRS for tax year 2017 AND
• A copy of the IRS’s approval of an extension beyond the automatic six-month extension
if the individual requested extension of the filing for tax year 2017 AND
• Verification of Non-filing Letter (confirmation that the tax return has not yet been
filed) from the IRS or other relevant tax authority dated on or after Oct. 1, 2018
AND
• All 2017 W2s and 1099s or
• If self-employed, a signed statement certifying the amount of the individual’s
Filed a Foreign Tax Return
for 2017?
• A signed and translated copy. Convert all figures to U.S. dollars
Was a Victim of IRS Tax-Related
Identity Theft?
• A Tax Return Database View (TRDBV) obtained from the IRS AND
• A statement signed and dated by the tax filer indicating that he/she was a victim of
IRS tax-related identity theft and that the IRS is aware of the tax-related identity theft
Tax filers may obtain a TRDBV transcript and inform the IRS of the tax-related identity theft
by contacting the IRS’s Identity Protection Specialized Unit (IPSU) at 1-(800)-908-4490
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1920V5 Dependent Verification Wksht (Solano Community College)

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Completed 25 July 2020

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