2019-20
CA Dream Act Application
Independent 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
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 household. Attach an additional sheet if necessary.
Please include: yourself and your spouse (if legally married), your children/step-children, if you will provide more than half of their support between
July 1, 2019 and June 30, 2020, even if they do not live with you, and other people if they now live with you and you provide more than half of their
support and you will continue to provide more than half of their support between July 1, 2019 and June 30, 2020.
Enrolled in College
at least half-time
(check one)
C. Federal Tax Return Filing Status – Student (and Spouse, if married). Please select the appropriate response.
I filed my 2017 return. Submit: 2017 IRS Tax Return Transcript. If married and you filed a joint 2017 IRS Income Tax Return,
Submit: 2017 IRS Tax Return Transcript. If married and you and your spouse filed separate 2017 IRS Income Tax Returns, Submit: 2017
IRS Tax Return Transcripts for both you (the student) and your spouse.
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
If married and you filed separate 2017 IRS Income Tax Returns, you must submit Tax Return Transcripts and Signed IRS
1040X form for both you (the student) and your spouse.
I will not and 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 will not and 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*
*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 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____________________
Spouse Signature: ______________________________________________________ Date____________________
(optional)
This worksheet must be signed and dated to be valid. Electronic and/or digital signatures are not valid.
Student’s Name: ________________________________________________ FRC ID: ________________________