Fillable 2015-VD6 2006-2007 Verification Worksheet

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2015-VD6 2006-2007 Verification Worksheet

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California Lutheran University – Office of Financial Aid
15-16
VD6
Dependent Verification Worksheet
Federal Student Aid Programs
Your 2015–2016 Free Application for Federal Student Aid (FAFSA) was selected for review in a process called verification. You and at least one
parent must complete and sign this worksheet, attach any required documents, and submit the form and other required documents to the Office
of Financial Aid. We may ask for additional information. Should you require further instructions, please contact our office at (805) 493-3115 or
finaid@callutheran.edu.
Complete items B – H of this worksheet with
responses from the parent whose information is on
the FAFSA. Amounts for the student should also be
included if the student has income that falls under any
of these categories/headings.
Please indicate, for each answer, if the response is for the student (S) or the parent (P)
If any item does not apply, enter “N/A” or “0”
If more space is needed, attach a separate page with the student’s name and ID
number at the top and include the additional information.
A. Student Information
Last Name
M.I.
CLU ID # or Social Security Number
@callutheran.edu
Date of Birth
E-mail address
Current phone number (include area code)
B. Payment to tax-deferred pension and retirement savings
List any payments (direct or withheld from earnings) to tax-deferred pension and retirement savings plans (e.g., 401(k) or 403(b) plans), including,
but not limited to, amounts reported on W-2 forms in Boxes 12a through 12d with codes D, E, F, G, H, and S.
Stu. /
Par.
Name of person who made the payment(s)
Total amount paid between
January 1 - December 31, 2014
$
$
C. Child Support Received
List the actual amount of any child support received in 2014 for the children in your household.
Do not include foster care payments, adoption payments, or any amount that was court-ordered but not actually paid.
Stu. /
Par.
Name of person who received child support
payment(s)
Name of child for whom child support was paid
Total amount received between
January 1 - December 31, 2014
$
D. Housing, food, and other living allowances paid to members of the
military, clergy, and others
Include cash payments and/or the cash value of benefits received.
Do not include the value of on-base military housing or the value of a basic military allowance for housing.
Stu. /
Par.
Name of recipient
Type of benefit received
Total amount received between
January 1 - December 31, 2014
$
E. Veterans non-education benefits
List the total amount of veterans non-education benefits received in 2014. Include Disability, Death Pension, Dependency and Indemnity
Compensation (DIC), and/or VA Educational Work-Study allowances.
Do not include federal veterans educational benefits such as: Montgomery GI Bill, Dependents Education Assistance Program, VEAP Benefits, Post-
9/11 GI Bill
Stu. /
Par.
Name of recipient
Type of Veterans non-education benefit
received
Total amount received between
January 1 - December 31, 2014
$
F. Other untaxed income
List the amount of other untaxed income not reported and not excluded elsewhere on this form. Include untaxed income such as workers’
compensation, disability, Black Lung Benefits, untaxed portions of health savings accounts from IRS Form 1040 Line 25, Railroad Retirement
Benefits, etc.
Do not include any items reported or excluded in B – E above. In addition, do not include student aid, Earned Income Credit, Additional Child Tax
Credit, Temporary Assistance to Needy Families (TANF), untaxed Social Security benefits, Supplemental Security Income (SSI), Workforce
Investment Act (WIA) educational benefits, combat pay, benefits from flexible spending arrangements (e.g., cafeteria plans), foreign income
exclusion, or credit for federal tax on special fuels.
Stu. /
Par.
Name of recipient
Type of other untaxed income
Total amount received between
January 1 - December 31, 2014
$
$
$
G. Money received or paid on the student’s or parent’s behalf
List any money received or paid on the student’s/parent’s behalf (e.g., payment of student’s/parents’ bills) and not reported elsewhere on this
form. If someone is paying rent, utility bills, etc., for the student/parent or gives cash, gift cards, etc., include the amount of that person's
contributions unless the person is the student’s parent whose information is reported on the student’s 2015–2016 FAFSA. Amounts paid on the
student’s behalf also include any distributions to the student from a 529 plan owned by someone other than the student or the student’s parents,
such as grandparents, aunts and uncles of the student, etc.
Stu. /
Par.
Purpose (e.g. Cash, Rent, Books, Cell Phone,
Auto Insurance…)
Source
Total amount received between
January 1 - December 31, 2014
$
$
$
H. Additional information
So that we can fully understand the student’s family's financial situation, please provide below information about any other resources, benefits,
and other amounts received by the student and any members of the student’s household. This may include items that were not required to be
reported on the FAFSA or other forms submitted to the financial aid office, and include such things as federal veterans education benefits, military
housing, SNAP, TANF, etc.
Stu. /
Par.
Name of recipient
Type of financial support
Total amount received between
January 1 - December 31, 2014
$
$
$
$
I. Certifications and Signatures
Each person signing below certifies that all of the information reported is complete and correct. The student and one parent whose information is
reported on the FAFSA must sign and date. WARNING: If you purposely give false or misleading information you may be fined, be sentenced to
jail, or both.
RETURN TO:
CLU Office of Financial Aid
60 West Olsen Road #1375
Thousand Oaks, CA 91360
EMAIL: finaid@callutheran.edu
FAX: (805) 493-3114
Student’s Signature - Required
Date
Parent’s Signature - Required
Date
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2015-VD6 2006-2007 Verification Worksheet

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Completed 12 February 2020

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