Office of Financial Aid San Bernardino Valley College
701 South M
ount Vernon Avenue San Bernardino, California 92410 (909) 384-4403
FINANCIAL AID OFFICE
2020-2021 Miscellaneous Self Certification Form
Last Name First Name MI Student ID Date of Birth
The Financial Aid Office at San Bernardino Valley College may use the information you provide on
this form to update your 2020-2021 FAFSA Application.
High School Diploma—Equivalency Statement
____ I have
a high school diploma from:
which I received on: __________(To be used to correct FAFSA only)
____ I have a GED from: which I received on: ______________ (To be used to correct FAFSA only)
____ I attended college prior to July 1, 2012 and previously passed a Department approved ability-to-benefit test (ATB).
(Proof must be provided to the Financial Aid Office)
____ I attended college prior to July 1, 2012 and was previously determined to have passed six credits of college work that are
applicable to a degree or certificate offered by San Bernardino Valley College.
____ I have passed a High School Proficiency exam (please note the CA certificate of completion is not eligible)
Yes_______ No_______ (check one)
Business Ownership
Do you (or your spouse if married) or your parent(s) (if Dependent) have a business which employs 100 or more full-time
employees?
Yes _____ No _____
If yes, please indicate the net worth of that business: $ ___________
Declining Financial Aid
_____ Please cancel my award(s) for the 2020-2021 award year.
Other
_____ Documentation is being requested based on the information I provided on my FAFSA that I have submitted during a
previous award year.
Certification and Signature
By signing below you are certifying that all of the information reported is complete and correct. WARNING: If you
purposely give false or misleading information, you may be fined, sent to prison, or both.
Student’s Signature Date
