Aggregate V5 Verification 2020-2021
Dr. H.A. Miller Student Services Center | 417 Schepps Blvd. | Clovis, NM 88101
Phone (575)769-4060 | Fax (575)769-4027
Your 2020–2021 FAFSA has been selected for a review process called verification. The law states that before awarding Federal
Student Aid, we will ask you to confirm the information you (and your parents if applicable) reported on your FAFSA. The financial aid
administrator at your school will compare your FAFSA with the information on this worksheet and with any other required documents.
If there are differences, your FAFSA information will be corrected. You (and at least one parent if dependent) must complete and sign
this worksheet and submit it, along with other required documents, to the financial aid office. If you have questions about verification,
contact the financial aid office as soon as possible so that your financial aid will not be delayed.
CCC ID Social Security Number Last Name First Name MI
Street Address City State Zip
Phone Number Email Address Date of Birth
Name Address Telephone Relationship
Dependent Students: List below the people in your parent(s) household. Include:
Yourself and your parent(s) (including a stepparent) even if you do not live with them.
Your parent(s)’ other children if your parent(s) will provide more than half of their support from July 1, 2020,
through June 30, 2021, or 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 they do not live with
your parent(s).
Others if they now live with your parent(s) and 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 Students: List below the people in your household. Include:
Your spouse, if you are married.
Your children, if any, that you will provide more than half of their support from July 1, 2020, through June 30, 2021, or
if the child would be required to provide
your
information if they were completing a FAFSA for 2020–2021. Include
children who meet either of these standards, even if they do not live with you.
Other people living with you which you provide more than half of their support and will continue to provide
more than half of their support through June 30, 2021
Include the name of the college for any household member who will be enrolled at least half time in a postsecondary
educational institution any time between July 1, 2020, and June 30, 2021.
Household Members Age Relationship to Student College
Self Clovis Community College
Student Information
Household Information
Reference
INCOME INFORMATION TO BE VERIFIED
Student
(
& S
p
ouse, i
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an
)
Filin
g
Status
(
al
l
student
s
)
Pa
r
ent
(
s
)
Filin
g
Status
(
de
p
en
d
ent st
u
d
ent
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)
Please
c
heck the box th
a
t applies:
I have filed my 2018 return and used the IRS Data Retrieval
Tool to transfer my income information.
I am attaching an IRS Tax Return Transcript.
I did not work/I did work in 2018 but was not required to file.
I am providing IRS confirmation of my non-filing (IRS
Verification of Non-filing Letter), and my IRS Wage and
Income Transcript.
Please
c
heck the box th
a
t applies:
My Parents have filed their 2018 return and used the IRS Data
Retrieval Tool to transfer their income information.
My Parents are attaching an IRS Tax Return Transcript.
My Parents did not work/my Parents did work in 2018 but they
were not required to file. They are providing IRS confirmation of
non-filing (IRS Verification of Non-filing Letter) and their IRS
Wage and Income Transcript.
2018 UNTAXED INCOME
Student/Spouse
Income Sources
Parent(s)
$
Untaxed IRA Distributions
$
$
Untaxed Pensions
$
$
Education Credits
$
$
IRA Deductions
$
$
Tax Exempt Interest
$
$
Active Duty BAS Allowance
$
$
Othe
r
Untaxed Income (specif
y
):
$
HIGH SCHOOL COMPLETION STATUS
Please provide and checkmark one of the following documents that indicate your high school completion status when you will begin college in
Fall 2020, Spring 2021 or Summer 2021:
A copy of the student’s high school diploma.
A copy of the student’s final official high school transcript that shows the date when the diploma was awarded.
A copy of the student’s High School Equivalency Credential certificate.
If State law requires a homeschooled student to obtain a secondary school completion credential for homeschool (other than a high
school diploma or its recognized equivalent), a copy of that credential.
If State law does not require a homeschooled student to obtain a secondary school completion credential for homeschool (other than a
high school diploma or its recognized equivalent), a transcript or the equivalent, signed by the student’s parent or guardian, that lists
the secondary school courses the student completed and documents the successful completion of a secondary school education in a
homeschool setting.
If you are unable to obtain documentation listed above, you must contact the CCC Financial Aid Office.
DEFERMENT AUTHORIZATON AGREEMENT – Students may cancel this DAA at any time in writing.
I authorize CCC to credit any financial aid I receive to my student account to pay for tuition, fees, bookstore charges and any other charges I may incur. I
understand that all charges will automatically be deducted from my financial aid. If my financial aid is canceled for any reason or if my financial aid does
not cover all my charges, I will be responsible for paying in full, any charges owed to CCC. I further understand that if I fail to pay these charges by midterm
of the semester I incurred them, a hold may be placed on my registration and my academic records. I will also be responsible for paying all costs
necessary for collections including legal costs and attorney fees plus interest on my account balance at the statutory rate. Furthermore, I understand that if
I do not authorize this deferment and I do not pay my charges (tuition, fees, etc.) by the scheduled deadlines my classes may be dropped.
Please INITIAL that you understand the Deferment Authorization Agreement: Date:
SIGNATURE(S) REQUIRED
Each person signing this worksheet certifies that all of the information reported on it, is complete and correct. Warning:
If you purposely give false or misleading information on this worksheet, you may be fined, be sentenced to jail, or both.
Student’s Signature: Date:
Parent’s Signature: (dependent student only) Date
Revised 03-12-19
click to sign
signature
click to edit
click to sign
signature
click to edit
CCC ID Student Name: _
IDENTITY AND STATEMENT OF EDUCATIONAL PURPOSE (To be signed at the institution)
The student must appear in person at Clovis Community College to verify his or her identity by
(Name of Postsecondary Educational Institution)
presenting a valid-government-issued photo identification (ID), such as, but not limited to, a driver’s license,
other state-issued ID, or passport. The institution will maintain a copy of the student’s photo ID that is
annotated with the date it was received and the name of the official at the institution authorized to collect the
student’s ID.
In addition, the student must sign, in the presence of the institutional official, the following:
Statement of Educational Purpose
I certify that I am the individual signing this
(Print Student’s Name)
Statement of Educational Purpose and that the federal student financial assistance
I may receive will only be used for educational purposes and to pay the cost of attending
Clovis Community College for 2020-2021.
(Name of Postsecondary Educational Institution)
(Student’s Signature) (Date)
(Student’s ID Number)
CopyofPhotoIDAttached
RHACOMMUpdated
Notarized
Archived
Financial Aid Office Use Only
Received Date Stamp:
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