INCOME INFORMATION TO BE VERIFIED
Student
& S
ouse, i
an
Filin
Status
al
student
Pa
ent
s
Filin
Status
de
en
ent st
ent
on
Please
heck the box th
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
heck the box th
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
Untaxed Income (specif
):
$
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
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