2800 S Lone Tree Rd
Flagstaff, AZ 86005-2701
PH: 928-226-4219
FAX: 928-226-4110
finaid@coconino.edu
FA-104 DVWS21 20200511
DEPENDENT VERIFICATION WORKSHEET
(2020-2021 Academic Year)
DVWS21
Your financial aid file was selected for a process called verification. Federal Regulation 34 CFR, Part 668 requires
colleges to compare your household’s 2018 financial documentation with the information provided on your Free
Application for Federal Student Aid (FAFSA). This process must be completed before CCC can offer you financial aid. If
there are differences between your FAFSA and your financial documents, CCC will correct your FAFSA. We may require
additional documentation if we have reason to believe the information on this form is inaccurate or incomplete. The
student and at least one parent must sign this form. If the student’s parents are separated/divorced, the parent who
information is on the FAFSA must sign.
Instructions for Section A:
Dependent Students (If you were required to report your parent’s information on the FAFSA)
1. List yourself and your parent(s), including legal stepparent, even if you do not live with your
parent(s).
2. List your parent(s) other children, even if they do not live with your parent(s) if your parent(s) will
provide more than half of their support from July 1, 2020 through June 30, 2021.
3. List other people currently living with your parent(s) for whom they will provide more than half of
their support from July 1, 2020 through June 30, 2021.
4. If you are unsure of who to list, please call us at 928-226-4219 so we can assist.
SECTION A. Complete this chart about the people in your household. Follow the above instructions carefully.
Household Member’s
First Name and Last Name
Age
Relationship
(to the
student)
College Attending in 2020-21
(if applicable)
Will this person be
enrolled at least
half time in a
degree, diploma or
certificate
program?
Y/N
Self
Coconino Community College
2800 S Lone Tree Rd
Flagstaff, AZ 86005-2701
PH: 928-226-4219
FAX: 928-226-4110
finaid@coconino.edu
FA-104 DVWS21 20200511
DEPENDENT VERIFICATION WORKSHEET
(2020-2021 Academic Year)
DVWS21
Instructions for Section B:
SECTION B. Tax Status and Requirements for Student: Check the box below that applies.
Student filed 2018 Federal Income taxes and used the IRS Data Retrieval Tool to transfer in the 2018 IRS
income information onto the FAFSA. Skip to Section C.
Student did not use the IRS Data Retrieval Tool on the FAFSA but did file 2018 Federal Income taxes.
Student must attach an official 2018 IRS Tax Return Transcript. Skip to Section C.
Student worked but was not required to file 2018 Federal Income Taxes. Complete the chart below AND
attach copies of your 2018 W-2’s.
Employer(s) in 2018
Student did not work in 2018 and is not required to file a tax return.
Instructions for Section C:
SECTION C. Tax Status and Requirements for Parent(s): If you were required to report parent(s) information on the
FAFSA, check the box below that applies.
Parent(s) filed 2018 Federal Income taxes and used the IRS Data Retrieval Tool to transfer in the 2018 IRS
income information onto the FAFSA. Skip to Section D.
Parent(s) did not use the IRS Data Retrieval Tool on the FAFSA but did file 2018 Federal Income taxes.
Spouse must attach an official 2018 IRS Tax Return Transcript. Skip to Section D.
Parent(s) worked but was not required to file 2018 Federal Income Taxes. Complete the chart below AND
attach copies of your spouse’s 2018 W-2’s. Also attach an IRS Non-Filing Letter for the 2018 tax year.
Employer(s) in 2018
Parent(s) did not work in 2018 and are not required to file 2018 Federal Income Taxes. Attach a copy of
the IRS Non-Filing Letter for the 2018 tax year.
Explain how your parent(s) financially supported their household in 2018.
SECTION D. Sign this Worksheet
I certify that information provided on this form is true and complete to the best of my knowledge. Purposely giving false or misleading
information may result in a delay or denial of my federal financial aid and I may be fined up to $20,000, sent to prison or both. I hereby
provide consent for the use of electronic records and signatures on all financial aid documents. I understand that if I choose to sign
electronically, my electronic signature constitutes a binding contract and may not be denied legal effect, validity, or enforceability
solely because it is in electronic form or because an electronic signature or electronic record was used in its formation.
Student Signature and Date
P
arent Signature and Date (must be signed and mailed for dependent students)
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