Fillable 2019-2020 Dependent Verification Worksheet

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2019-2020 Dependent Verification Worksheet

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721 Cliff Drive • Santa Barbara, California 93109‐2394 • Phone (805) 730-5157 • Fax (805) 564‐1893
2019-2020
DEPENDENT VERIFI
CATION WORKSHEET
Your application was selected for verification. This process requires our office to compare information from your financial aid
application with copies of your and your parents’ 2017 Federal Tax Return Transcripts or other financial documents. Federal and state
regulations authorize the SBCC Financial Aid Office to request this information before awarding student aid. If there are differences
between your application and your financial documents, we will submit these corrections electronically to the FAFSA processor.
Complete and sign this worksheet; do not leave any fields blank
Submit all documentation to our office at the address located at the bottom of the page
Check your pipeline account for supplemental requests
A. STUDENTINFORMATION
List the people in your parents’ household, including:
• yourself and your custodial parents (including stepparent) even if you don’t currently live with your parents, and
• your parents’ other children, even if they don’t live with your parents, if:
o your parents will provide more than half of their support from July 1, 2019 through June 30, 2020, or
o thechildrenwouldberequiredtoprovideparentalinformationwhenapplyingforfederalstudentaid and
• other people only if they now live with your parents and your parents provide more than half of their support and will continue to provide more
than half of their support from July 1, 2019 through June 30, 2020.
Writethenamesofallhouseholdmembersinthespace(s)below.Alsowritethenameofthecollegeforanyhouseholdmember,
excluding your parents, who will be attending college at least half-time between July 1, 2019 and June 30, 2020, and will be enrolled in a degree,
diploma, or certificate program.
Full Na
me
Age
Relationship To
Student
College and Federal Scho
ol Code
Enrolled At Least
6 Units (Yes/No)
Example: Johnny Valentine 45 Father N/A
N/A
1.
Self Santa Barbara City College - 001285
2.
3.
4.
5.
6.
7.
8.
9.
10.
If you need more space, attach a separate page.
Last Name (Print)
First Name M.I. Student ID (K00 Number)
Pipeline Email
B. FAMILYINFORMATION
Phone Number
1
Financial Aid Office: www.sbcc.edu/financialaid/
721 Cliff Drive • Santa Barbara, California 93109-2394 • Phone (805) 730-5157 • Fax (805) 564-1893
C. STUDENT’S INCOME INFORMATION TO BE VERIFIED
I Have Filed a 2017 Federal Tax Return
Federal 2017 Tax Information – select one option:
o I have used the IRS Data Retrieval Tool on the FAFSA. (This tool is unavailable for the CA Dream Act Application).
o I have attached a copy of the 2017 Tax Return Transcript.
The Tax Return Transcript is available at www.irs.gov or by calling 1-800-908-9946.
Click here for further instructions. If you filed an amended tax return, a tax extension or have any other unusual
circumstance, please click here.
I Was Not Required to File a 2017 Federal Tax Return
I worked, but will not file.
o I have attached copies of all W-2 statements OR a Wage and Income Transcript for 2017.
o I do not have W-2 statements for 2017, as I was self-employed.
I have listed all sources of income below.
I did not work.
o I have listed all sources of income below. Enter n/a or $0, if you had no sources of income.
Sources of Income and Employer Information for Non-filers Amount
1. Source/Employer’s Name: $
2. Source/Employer’s Name: $
D. PARENT’S INCOME INFORMATION TO BE VERIFIED
My Parents Filed a 2017 Federal Tax Return
Federal 2017 Tax Information – select one option:
o My parents have used the IRS Data Retrieval Tool on the FAFSA. (This tool is unavailable for the CA Dream Act
Application).
o I have attached a copy of my parent's 2017 Tax Return Transcript.
The Tax Return Transcript is available at www.irs.gov or by calling 1-800-908-9946.
Click here for further instructions. If you filed an amended tax return, a tax extension or have any other unusual
circumstance, please click here.
- OR -
2
My Parents Were Not Required to File 2017 Federal Tax Return
My parents worked, but will not file*
o I have attached a copy of my parent's 2017 Verification of Non-Filing Letter from the IRS and have listed all
sources of income below.
o I have attached copies of all W-2 statements OR a Wage and Income Transcript for 2017.
o My parents do not have W-2 statements for 2017, as they were self-employed.
My parents did not wor
k*
o I have attached a 2017 Verification of Non-Filing Letter from the IRS and have listed all sources of income
below.
o Enter $0 or N/A if your parents' had no source of income.
Sources of Income and Employer Information for Non-filers Amount
1. Source/Employer’s Name: $
2. Source/Employer’s Name: $
- OR -
721 Cliff Drive • Santa Barbara, California 93109‐2394 • Phone (805) 730-5157 • Fax (805) 564‐1893
F. ASSETINFORMATION (Enter $0 if not applicable.)
**Investmentsinclude:realestate(do notincludingthehomeinwhichyoulive)rentalproperty,trustfunds,moneymarketfunds,mutual funds,
certificates of deposit, stock, stock options, bonds, etc.
***Do not include the value of a small business if your family owns and controls more than 50 percent of the business and the business has 100 or
fewer full-time employees.
G. SIGNATURES
Student’sSignature
Date
Parent’sSignature
Date
In 2017 or 2018, did anyone in your parents’ household receive:
Medicaid SupplementalSocialSecurityIncome(SSI) SupplementalNutritionAssistanceProgram(SNAP) N/A
Temporary Assistance for Needy Families (TANF) Spec
ial Supplemental Nutrition Program for Women, Infants, and Children (WIC)
Reportamountsasofthedateyourfinancial aid applicationwassubmitted. STUDENT
PARENTS
Total cash, savings, and checking accounts $
$
Net worth of current investments**
$
$
Net worth of businesses and/or investment farms***
$
$
I certify that all the information on this form and any attachments and subsequent information provided to the SBCC Financial Aid
Office is true, complete and accurate to the best of my knowledge. I understand that false statements or misrepresentations will be
cause for denial, reduction, withdrawal and/or repayment of financial aid and referral to appropriate administrators under AP 500
Standards of Student Conduct.
Ifyourparentsdidnotfilea2017FederalTaxReturn,oriftheincomeinformationreportedonthefinancial aid application
appearslow as it relates to the family size,please explainhowlivingexpensesweremetinthespacebelow.
Comments:
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
E. ADDITIONALFINANCIALINFORMATION
3
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2019-2020 Dependent Verification Worksheet

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Completed 7 March 2020

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