1
2020-2021
Form #1 Standard Verifcation Group
Your Free Application for Federal Student Aid (FAFSA) was selected for review process called “Verification”. In this process we
compare your FAFSA with information on this worksheet and other required documents, such as your 2018 IRS tax information.
If there are differences, the Financial Aid Office will make the necessary changes. The Financial Aid Staff will not make any
financial aid payments to you until all verification and required documentation have been met and the necessary corrections have
been made under the financial aid program regulation (34CFR, part 668).
STUDENT INFORMATION
Last Name (Please Print) First Name M.I. Date
of Birth
Peralta Student ID
Last 4-digits of SSN
Telephone Number to best reach you
FAMILY/HOUSEHOLD INFORMATION (Please check one of the boxes below).
Dependent Student: List the people in your parents household. Include yourself, your parent(s) (including stepparent) even if you don’t
live with your parents, and other children if (a) your parents will provide more than half of their support between July 1, 2020 and June 30,
2021, or (b) if the other children would be required to provide parental information if they were completing a FAFSA for 2020-2021.
Include children who meet either of these standards even if the children do not live with the parents. Also include any other people who
now live
with your parent(s) and for whom your parent(s) provide more than half of their support and will continue to provide more than
half of their support
through June 30, 2021.
Independent Student: List the people in your household. Include yourself, your spouse (if married), and children if you will provide
more
than half of their support between July 1, 2020 and June 30, 2021, even if the children do not live with you. Include also, any other people
who now live with you and for whom you are providing more than half of their support and will continue to provide more than half of their
support between July 1, 2020 and June 30, 2021.
Write the names of all household members including yourself. Also write the name of the college for any family member, excluding
your parent (if dependent), who will be attending college at least half-time in a degree, diploma, or certificate program at an eligible
postsecondary educational institution between July 1, 2020 and June 30, 2021. Include the name of the college. If more space is needed, attach
a separate page with the student’s name and Peralta Student ID# at the top.
Full Name Age
Relationship to
Student
College Attending
Theodore Cleaver (example) 19 Brother Yellowstone University
Berkeley City College
2050 Center Street
Berkeley, CA
510.981.2805
College of Alameda
555 Ralph Appezzato Mem.Pkwy
Alameda, CA 94501
510.748.2228
Laney College
900 Fallon Street
Oakland, CA 94607
510.464.3314
Merritt College
12500 Campus Drive
Oakland, CA 94619
510.436.2465
Rev. 5/22/2020 JV
2
STUDENT’S (AND SPOUSE’S, IF MARRIED) INCOME & BENEFITS INFORMATION
Check the appropriate box below and
provide the requested information and
documents:
Employer’s Name
2018 Amount
Earned
IRS W-2, 1099
Provided?
Acme Auto Body Shop (example) $2,000.00
Yes
PARENTS’ INCOME & BENEFITS INFORMATION (Dependent Students Only)
Check the appropriate box below and provide the requested information and docu
ments:
I/we used the IRS Data Retrieval Tool to transfer my/our 2018 income information to the FAFSA.
I/we did not (or could not) transfer my/our 2018 income information to the FAFSA using the IRS Data Retrieval Tool. I/we have
attached a copy of my/our 2018 IRS Tax Return Transcript(s).
I was not employed, had no income earned from work in 2018, and did not and was not required to file taxes for 2018. I provided a
copy of my IRS Verification of Non-Filing Letter for 2018.
I/we worked but did not and was not required to file a 2018 Federal Income Tax Return. I/we have listed below the names of all
employers, the amount earned from each employer in 2018, whether an IRS W-2 form or 1099 is provided. I/we listed every
employer
even if the employer did not issue an IRS W-2 or 1099 form. I/we provided copies of all 2018 IRS W-2 and/or 1099 forms
issued to
me/us and provided verification from the IRS of Non-Filing status.
Employer’s Name
2018 Amount
Earned
IRS W-2, 1099
Provided?
Acme Auto Body Shop (example) $2,000.00
Yes
CERTIFICATION AND SIGNATURE
By signing below, I/we certify the information reported on this worksheet is complete and accurate and authorize the Financial Aid Office to
perform necessary electronic ISIR correction on my behalf. I/we agree to provide proof of any information reported on this form or on my
FAFSA or Dream Act. I/we realize that any false statement or failure to give pr
oof when asked may be cause for denial, reduction, withdrawal,
and/or repayment of my financial aid. I/we also understand if we purposely give false or misleading information I/we may be fined, sentenced
to jail or both. If you are an independent and married student, a spouse signature is optional. If you are a dependent student, one parent must
sign below.
Student signature
Date
Spouse signature (if married) or Parent Signature (if a dependent student) Date
Rev. 5/22/2020 JV
I/we used the IRS Data Retrieval Tool to transfer my/our 2018 income information to the FAFSA.
I/we did not (or could not) transfer my/our 2018 income information to the FAFSA using the IRS Data Retrieval Tool. I/we have
attached a copy of my/our 2018 IRS Tax Return Transcript(s).
I (and, if married, the student’s spouse) was not employed and had no income earned from work in 2018. I have provided a copy of my
IRS Verification of Non-Filing Letter for 2018 (for independent students only).
I (and, if married, the student’s spouse) have income earned from work and not required to file a 2018 income tax return with the IRS. I
have entered all income information below, listing the names of all employers. I have provided copies of all 2018 IRS W-2 forms and/
or 1099 forms. In addition, I have provided a copy of my IRS Verification of Non-Filing Letter for 2018 (for independent students only).
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