Fillable Financial Aid Statement Form (California State University Channel Islands)

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Financial Aid Statement Form (California State University Channel Islands)

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FA-25 / 18-19 Page 1 of 1
2018-2019 Financial Aid Statement
PLEASE RETURN THIS FORM TO THE CSU CHANNEL ISLANDS FINANCIAL AID & SCHOLARSHIPS OFFICE
One University Drive, Camarillo, California 93012-8599 financial.aid@csuci.edu www.csuci.edu/financialaid Tel: (805) 437-8530
Student Last Name
Student First Name
CSUCI ID Number
Student Phone Number
Purpose
In the box below, type a statement (handwritten statements will not be accepted) regarding any of the following reasons:
Tax Extension Filers: to confirm your estimated Adjusted Gross Income and Taxes Paid for the 2016 tax year
Identity Theft Victims: to confirm that you were a victim of IRS tax-related identity theft and the IRS has been made aware
of your circumstances
Other: to confirm or resolve any conflicting information that was submitted to the Financial Aid & Scholarships office if
requested by a Financial Aid representative or for any other general statements you wish to submit
Note: If additional space is needed, please submit and attach additional Financial Aid Statement Form(s).
Statement
I attest to the following:
Signature
Each person signing this worksheet certifies that all of the information reported on this form is true and accurate to the best of their
knowledge.
WARNING:
If you purposely give false or
misleading information on this
form, you may be fined, sentenced
to jail, or both.
Student Signature (electronic signatures not accepted)
Date
Parent Signature* (electronic signatures not accepted)
*for dependent students only – if applicable
Date
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Financial Aid Statement Form (California State University Channel Islands)

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Completed 24 July 2020

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