2019-20
CA Dream Act Application
Dependent Verification Worksheet
Feather River College – Financial Aid Office – 570 Golden Eagle Avenue, Quincy CA 95971
Phone (530) 283-0202 ext 603 – Fax (530) 283-4659 – Email: financialaid@frc.edu
www.frc.edu/financialaid
DV1W20
Your California Dream Act Application (CADAA) has been selected for a process called verification. Please complete all parts of this worksheet and
return to the Financial Aid Office. Notice: incomplete forms may delay processing.
B. Household Information – List the members in your parents’ household. Attach an additional sheet if necessary.
Please include: yourself, even if you don’t live with your parents, your parents/step-parent (if your parent is remarried you must include your step-
parent), your parents’ other children (even if they do not live with your parents), siblings, and individuals who will receive more than half of their
support from your parents between July 1, 2019 and June 30, 2020.
Enrolled in College
at least half-time
(check one)
C. Tell us about your 2017 tax filing status –
Student’s Filing Status (select only one)
• I filed my 2017 return. Submit your 2017 IRS Tax Return
Transcript.
• I amended my taxes after originally filing my 2017 return
and will submit:
o 2017 IRS Tax Return Transcript
o 2017 Signed IRS 1040X form
• I did not and I am not required to file a federal tax return. I
was not employed and earned no income from work in 2017.
Submit 2017 IRS Verification of Non-filing Letter*
• I did not and I am not required to file a federal tax return. In
2017, I earned $__________ from the source(s) listed below:
Submit 2017 IRS Verification of Non-filing Letter*
Attach all W-2s issued to you in 2017
*IRS Verification of Non-Filing Letters can be requested by checking box 7 and
8 (if no W-2s provided) on IRS Form 4506-T. Notice: 2017 IRS Verification of
Non-Filing Letters must be dated on or after October 1, 2018.
Parent(s) Filing Status (select only one)
• My parent(s) filed their 2017 tax return. Submit parent’s
2017 IRS Tax Return Transcript.
• My parent(s) amended their taxes after originally filing
their return and will submit:
o 2017 IRS Tax Return Transcript
o 2017 Signed IRS 1040X form
• My parent(s) did not and is/are not required to file a federal
tax return. My parent(s) were not employed and earned no
income from work in 2017. Submit 2017 IRS Verification of
Non-filing Letter*
• My parent(s) did not and is/are not required to file a federal
tax return. In 2017, my parent(s) earned $___________
from the source(s) listed below: Submit 2017 IRS Verification of
Non-filing Letter*
Attach all W-2s issued to your parent(s) in 2017
*IRS Verification of Non-Filing Letters can be requested by checking box 7 and
8 (if no W-2s provided) on IRS Form 4506-T. Notice: 2017 IRS Verification of
Non-Filing Letters must be dated on or after October 1, 2018.
D. 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 whose information was reported on the California Dream Act Application (CADAA) must
sign and date. Warning! If you purposely give false or misleading information you may be fined, sentenced to jail, or both.
Student Signature: _____________________________________________________ Date: ___________________
Parent Signature: ______________________________________________________ Date: ___________________
This worksheet must be signed and dated to be valid. Electronic and/or digital signatures are not valid.
Student’s Name: ________________________________________________ FRC ID: ________________________