210/SSIC (Rev. 01/16/08, rlq)
Fax: (562) 467-5035
ame of Financial Aid Applicant (Please print)
Student #:____
Cerritos College
Financial Aid Office
11110 Alondra Blvd.
Norwalk, CA 90650
ast First Middle
Student ID Number: ___________________________________________
turn, including all schedules and
ot required to file, a 2007
federal income tax return.
Attached is a signed photocopy of my/our 2007 f
income tax re
I/We did not file, and are n
List below all of the sources and amounts of money received from January 1, 2007 through December 31, 2007. Include
untaxed income (e.g., AFDC/TANF/CalWORKs, SSI, Military Living Allowance, disability) and earnings or income not
reported on a federal or state income tax return (e.g., unemployment income if a tax return was not filed).
Source of Money 2007 – December 2007
Annual Amount
If you claim to be a self-supporting student and if your income was not sufficient to pay rent, food, and other expenses,
xplain how your expenses were met: (You may attach a separate sheet if additional space is needed.) e
I/We hereby certify that all information reported on this form and any attachments hereto is true, complete, and accurate.
tion, withdrawal, and/or repayment of financial aid.
ignatures are required for all persons reporting income above.
False statements or misrepresentation will be cause for denial, reduc
Signature of Applicant Date
Signature of Applicant’s Spouse Date
ame of Applicant’s Spouse (Please print)
California Information Privacy Act
State and federal laws protect an individual’s right to privacy regarding information pertaining to oneself. The California Information Practices Act of 1977 requires the
following information be provided to financial aid applicants who are asked to supply information about themselves. The principal purpose for requesting information on this
form is to determine your eligibility for financial aid. The Chancellor’s Office policy and the policy of the community college to which you are applying for aid authorize
maintenance of this information. Failure to provide such information will delay and may even prevent your receipt of financial assistance. This form’s information may be
transmitted to other state agencies and the federal government if required by law. Individuals have the right of access to records established from information furnished on this
partnership or any other legally protected basis. Inquiries regarding these policies may be directed to the financial aid office of the college to which you are applying.
form as it pertains to them.
The officials responsible for maintaining the information contained on this form are the financial aid administrators at the institutions to which you are applying for financial
aid. The SSN may be used to verify your identity under record keeping systems established prior to January 1, 1975. If your college requires you to provide an SSN and you
have questions, you should ask the financial aid officer at your college for further information. The Chancellor’s Office and the California community colleges, in compliance
with federal and state laws, do not discriminate on the basis of race, religion, color, national origin, gender, age, disability, medical condition, sexual orientation, do
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