Fillable Financial Aid Document Submission Cover Sheet (California State University, Dominguez Hills)

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Financial Aid Document Submission Cover Sheet (California State University, Dominguez Hills)

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The Financial Aid Document Submission Cover Sheet (California State University, Dominguez Hills) form is 3 pages long and contains:

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  • 6 check-boxes
  • 74 other fields

Country of origin: US
File type: PDF

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FINANCIAL AID OFFICE
1000 East Victoria Street, WHB250
C
arson, California 90747
P
HONE: (310) 2 43-3691
CSUDH ID: _____________________________ _______________
Today’s Date:
Financial Aid Document Submission Cover Sheet
Please complete the information requested below, submit this form along with your
documents. REMINDER: When uploading your documents to the DropBox, please
exercise caution when using Free WiFi or Public Computers as these are not secure.
Student Name: ________________________________________________________
Enter Last Name, First Name, MI
Toro Email Address: ____________________________________
Phone Number: ______ ________________________________
(Area Code) (i.e. 222-1234)
Be sure to include your CSUDH student ID number on the front and back of each
page submitted and allow 24-48 hours for your To Do List to be updated.
Submission Instructions
In the following page(s), complete all requested information using the fillable
document below. Your document must be complete to be accepted by the Financial
Aid Office. Forms that are incomplete will remain on your To-Do list in the Student
Center.
1. Upon completing this document, scroll to the bottom where you are asked to sign and
date. In the signature area, type your name and in the date space type today’s date.
2. Save your document. Name your document with your Initials and CSUDH ID #
3. If you have attachments, please have them ready to upload to the DropBox
4. Return to the Financial Aid Forms section to the “Submit My Documents link”
5. Once all documents have been submitted, be sure to close your browser.
-------------------
In furtherance of CSU Dominguez Hill’s mission of accessibility and commitment to excellence through diversity, equity, and
inclusion, CSUDH strives to ensure that its information and communication technology is accessible to everyone. If you need
assistance in completing this form because of a disability, please contact us at (310) 243-3660
---------------------
FINANCIAL AID OFFICE
1000 East Victoria Street, WHB250
Carson, California 90747
(310) 243-3691
finaid@csudh.edu
Student’s Name:
CSUDH ID#:
2021-2022 Independent Verification Form
Your 2021-2022 Free Application for Federal Student Aid (FAFSA) or California Dream Act Application (CADAA) was
selected by the federal/state processor for secondary review in a process called verification. Student applications are
randomly selected and you are asked to validate the information provided on your application is accurate. CSUDH will
compare your FAFSA or CADAA data with the information on this form and with any other submitted documents. If there
are any differences, CSUDH may need to correct information on your application.
A. INDEPENDENT STUDENT’S FAMILY INFORMATION
List below the people in your household. Include:
Yourself;
Your spouse, if you are married;
Your children, if you will provide more than half of their support from July 1, 2021 – June 30, 2022, even if the
children do not live with you.
Other people if they now live with you AND you provide more than half of the other person’s support, and will
continue to provide more than half of that person’s support through June 30, 2022.
Full Name
Age
Relationship
College*
Will be enrolled at
least half time
(Yes/No)*
Self
CSU Dominguez Hills
*Include the name of college for any listed household member and if he/she is, or will be, enrolled at least half
time in a degree, or undergraduate certificate program at an eligible postsecondary educational institution any
time between July 1, 2021 and June 30, 2022. Additional documentation may be requested if we have reason to
believe that the information regarding the household member enrolled in the eligible postsecondary educational
institution is inaccurate.
If more space is needed, attach a separate page with your name and Student ID Number at the top.
Updated 1/2021
FVRI21
Student’s Name: CSUDH ID#:
B. STUDENT’S INCOME INFORMATION (Check only ONE response)
I have used the IRS Data Retrieval Tool (DRT) in FAFSA on the Web to transfer my (and my spouse’s, if
married) 2019 IRS income tax return information into my FAFSA.
I have filed and attached a signed copy of my (and my spouse’s, if married) 2019 U. S. Individual Income Tax Return
(Form 1040) with all schedules.
I (and/or my spouse, if married) was not required by federal law to file a 2019 U. S. Individual Income Tax
Return (Form 1040) with the IRS.
Please submit one of the following documents and complete the table below.
IRS Verification of Non-Filing Letter (dated on or after October 1, 2020)
Request for FREE online at: http://www.irs.gov– Click on “Get Your Tax Record” then select “Get
Transcript ONLINE” or “Get Transcript by MAIL.” Make sure to request the “Verification of Non-
Filing Letter.”
2021-2022 Non-Filing Letter Exception form
Available on the CSUDH Financial Aid Office website at csudh.edu/financial-aid/
forms/.
Listed below are all earnings from work and sources of financial assistance I (and/or spouse, if married) received
in 2019 to meet basic living expenses. If earnings are from work, I have attached copies of all 2019 W-2 forms
issued to me (and/or spouse, if married) by each employer.
Source (Name of Employer, Person, agency, etc.)
Type (work, benefits, family
assistance, financial aid, etc.)
2019 Amount
Student
2019 Amount
Spouse
Total Amount of Income Earned From Work
$ $
Total Amount of Assistance Received
$
$
If more space is needed, attach a separate page with your name and Student ID Number at the top.
C. If you (and/or your spouse, if married) changed or corrected your original 2019 income tax return filed with the
IRS, you must submit the following:
Signed copy of the 2019 Amended U.S. Individual Income Tax Return (1040X) with all schedules attached
that was filed with the IRS.
D. CERTIFICATION AND SIGNATURE
WARNING: Per the U.S. Department of
Education and the State of California, if you
purposely give false or misleading information
you may be fined, be sentenced to jail, or both.
Each person signing below certifies that all of the information
reported is complete and correct.
Student’s Signature (Required) Date
Spouse’s Signature (Optional) Date
Updated 1/2021
FVRI21
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Financial Aid Document Submission Cover Sheet (California State University, Dominguez Hills)

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Completed 26 February 2021

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