Fill - Free fillable Form 5307497999: F A O 20202021DependentSupportVerification (Woodland Community College) PDF form

YubaCommunityCollegeDistrict

inancial

id

ffices



2020‐2021DependentSupportVerification



Thereisadiscrepancywiththedependent(s)and/orincomeyoureportedonyour2020‐2021FAFSAorVerificationWorksheet

thatneedstoberesolvedbeforetheFinancialAidOfficecandetermineyoureligibilityforfinancialaid.Pleasecompleteand

returnthisformtotheFinancialAidOfficeatyourcampus.



Pleaseanswerallquestions.Donotleaveanyitemsblank.Ifanitemdoes notapply,enter N/Aor$0intheareawhere an

amountisrequested.SubmitthisformwithsupportingdocumentationtotheFinancialAidOffice.



Note:Ifyouareunabletomeettheminimumsupportrequirements

setforthbyYCCDandFederalRegulationsandyouare

undertheageof24,youwillberequiredtoaddyourparent’sinformationtoyourexistingFAFSAapplication.



STUDENTINFORMATION



_____________________________________________________ __________________________________

LastName    FirstStudentID



_________________________________________________________

__________________________________



MailingAddress(includeapt.no.)PhoneNumber(IncludeAreaCode)



_________________________________________________________ 

City    State ZipCode



A.INDIVIDUALWHOMISCOMPLETINGTHISFORM:



IndependentStudent:Thatfinanciallysupportsadependentmorethan50%



DependentStudent’sParent:Thatfinanciallysupportsadependentotherthanachildmorethan50% 

B.DEPENDENTINFORMATION

CHECKTHEBOXTHATAPPLIESTOYOU  SUBMITTHEFOLLOWINGDOCUMENTATION

IDONOThaveadependentforwhomIprovidemorethan50%

oftheirfinancialsupport.

 Noadditionaldocumentationrequired.



IDOhaveadependentforwhichIprovidemorethan50%of

theirfinancialsupport.

 CompletetheProofofDependentSupportform

 Provideproofofincomeearnedorbenefits

received

fromJuly1,2020toJune30,2021.



Dependentsare:

 Yourchildrenifyouwillprovidemorethan50%oftheirsupportfromJuly1,2020throughJune30,2021,eveniftheydonot

livewithyou.

 Otherdependentsiftheynowlivewithyou,andyouprovidemorethan50%oftheirsupportandwillcontinueto

providemore

than50%oftheirsupportthroughJune30,2021.



COMPLETEALLITEMSFOR

EACHDEPENDENT

DEPENDENT1 DEPENDENT2



NameofDependent



DateofBirth





Relationship





Page1DependentSupportVerification

YubaCollege

2088NorthBealeRoad

Marysville,CA95901

530‐749‐7999



WoodlandCommunityCollege

2300EastGibsonRoad

Woodland,CA95776

530‐661‐5725



LakeCounty Campus

15880DamRoadExtension

Clearlake,CA95422

707‐995‐7923

C.HOUSEHOLDINFORMATION

COMPLETEALLITEMSFOR

EACHDEPENDENT

DEPENDENT1 DEPENDENT2

Wheredoesthedependentlive?



Ifother,listthe:

1.Nameofthepersonwhotheylivewith.



2.Theirrelationshiptothedependent.



3.Howlongtheyhavelivedwiththe

otherperson.

WiththestudentOther



Withthestudent’sparent

WiththestudentOther



Withthestudent’sparent







D.ADDITIONALHOUSEHOLDINFORMATION

1.Enterthetotalnumberofpeoplewholiveinyourhousehold:_____________________

2.Enterthetotalnumberofpeoplewholiveinyourhouseholdthatyoufinanciallysupport._____________________

3.Howlonghasthedependentlivedwithyou?

Dependent1___________________________________Dependent2___________________________________

4.HowmanymonthswillthedependentliveinyourhouseholdfromJuly1,2020toJune30,2021?

Dependent1___________________________________Dependent2___________________________________

E.INCOME

COMPLETEALLITEMSFOR

EACHDEPENDENT

DEPENDENT1 DEPENDENT2

Wasthedependentclaimedonyour2019

FederalTaxReturn?Ifno,listthe:

1.Nameofthepersonwhoclaimedthem.

2.Person’srelationshiptothedependent.

 Yes  No  Yes  No





INCOMEINFORMATIONFORSTUDENTORPARENT

Pleaseanswerthefollowingquestions:

CheckOne

Provideproofofincomeearnedorbenefitsreceived

fromJuly1,2020toJune30,2021.Submitthe

followingdocumentation:

Areyoucurrentlyworking? YesNo RecentpaycheckstubwithYTDtotal

Doyoureceivechildsupport? YesNo CourtDocument/BankStatements/CopyofChecks

DoyoureceiveSocialSecurityBenefits? YesNo SocialSecurityStatement:Type____________________

DoyoureceiveTANF,CalWorks,orTribalTANF? YesNo NoticeofAction/PassporttoServices

DoyoureceiveSNAP,CalFresh,orfoodstamps? YesNo Statementfromagencythatissuedthebenefits

DoyoureceiveWICbenefits? YesNo Statementfromagencythatissuedthebenefits

Doyoureceiveanyothertypeofincome? YesNo Proofofincome/benefitstudentorparentisreceiving

Doyoureceivesupportfromanyoneelse? YesNo Proofofsupportstudentorparentisreceiving



INCOMEINFORMATIONFORDEPENDENTYOUSUPPORT

Doesthedependentyousupporthaveincome? YesNo Proofofincome/benefits

Doesthedependentyousupportreceiveany

financialsupportfromothersources?

YesNo

Proofofsupportfromagencyorindividualthat

providedthesupport

Doesthedependentyousupportcontribute

towardsthecostofhouseholdexpenses?

YesNo

Howmuchdotheycontributepermonth?

$_______________________

Page2DependentSupportVerification

F.HOUSEHOLDEXPENSES



G.DEPENDENTEXPENSES



H.SUPPORTEVALUATION

ThisinformationwillbeusedbytheFinancialAidOfficetodeterminewhetheryouprovidemorethanhalfofthesupportfor

thedependentsyouhavelisted.

I.CERTIFICATION



Icertifythattheinformationprovidedonthisformandanyattachmentsistrueandcorrecttothebestofmyknowledge.Iunderstand

thatfalseormisleadinginformationmaybecausefordenial,termination,and/orrepaymentoffinancialaidfunds.



_______________________________________________________ _______________________________________________________

StudentSignatureDate ParentSignature    Date



FORFINANCIALAIDOFFICEUSEONLY

 SupportTestWorksheetCompletedDateCompleted:__________________________

 Approved:MeetssupporttestDateAwarded:__________________________ISIR:____________EFC:__________________

 Denied:Doesnotmeetsupporttest Studentconsidered“dependent”andmustprovideparent(s)informationontheirFAFSA.

Comments:____________________________________________________________________________________________________

___________________________________________________________________________________________________



_______________________________________________________ 

FAStaffSignatureDate 



Page3DependentSupportVerification

Rev.9/27/19

ProvideExpensesfor

EntireHousehold:

CurrentMonthly

Expense

AmountYouPay

PerMonth

AmountSomeone

ElsePays



NameifSomeoneElsePays

Rent/Mortgage



Utilities(Water,Electricity,

Gas,Trash)



OtherExpenses(Phone/Cell,

Cable,Internet)



Food



Transportation(carpayment,

gas,autoinsurance)



TotalMonthlyExpenses



Provideexpensesfor

Dependent:

CurrentMonthly

Expense

AmountYouPay

PerMonth

AmountSomeone

ElsePays



NameifSomeoneElsePays

Childcare



ClothingandotherPersonal

Expenses



Other:__________________



TotalMonthlyExpenses



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Form 5307497999: F A O 20202021DependentSupportVerification (Woodland Community College)

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