V1 Verification Worksheet 2020-2021
Dr. H.A. Miller Student Services Center | 417 Schepps Blvd. | Clovis, NM 88101
Phone (575)769-4060 | Fax (575)769-4027
Your 2020–2021 FAFSA has been selected for a review process called verification. The law states that before
awarding Federal Student Aid, we will ask you to confirm the information you (and your parents if applicable)
reported on your FAFSA. The financial aid administrator at your school will compare your FAFSA with the
information on this worksheet and with any other required documents. If there are differences, your FAFSA
information will be corrected. You (and at least one parent if dependent) must complete and sign this worksheet
and submit it, along with other required documents, to the financial aid office. If you have questions about
verification, contact the financial aid office as soon as possible so that your financial aid will not be delayed.
CCC ID Social Security Number Last Name First Name
Street Address City State Zip
Phone Number Email Address Date of Birth
Name Address Telephone Relationship
Dependent Students: List below the people in your parent(s) household. Include:
Yourself and your parent(s) (including a stepparent) even if you do not live with them.
Your parent(s)’ other children if your parent(s) will provide more than half of their support from July 1,
2020, through June 30, 2021, or if the other children would be required to provide parental information if they
were completing a FAFSA for 2020–2021. Include children who meet either of these standards, even if they do
not live with your parent(s).
Others if they now live with your parent(s) and your parent(s) provide more than half of their support and
will continue to provide more than half of their support through June 30, 2021.
Independent Students: List below the people in your household. Include:
Your spouse, if you are married.
Your children, if any, that you will provide more than half of their support from July 1, 2020, through June 30,
2021, or if the child would be required to provide
your
information if they were completing a FAFSA for 2020–
2021. Include children who meet either of these standards, even if they do not live with you.
Other people living with you which you provide more than half of their support and will continue to
provide more than half of their support through June 30, 2021
Include the name of the college for any household member who will be enrolled at least half time in a
postsecondary educational institution any time between July 1, 2020, and June 30, 2021.
Household Members Age Relationship to Student
College
Self Clovis Community College
Student Information
Household Information
Reference
Income Information to be Verified
Please check the box that 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 an IRS Verification of
Non-Filing Letter, and if applicable, my IRS Wage
and Income Transcript.
Please check the box that 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/did work in 2018 but they were not
required to file. They are providing an IRS Verification of
Non-Filing Letter and, if applicable, their IRS Wage and
Income Transcript.
2018 Untaxed Income
Student/Spouse
Income Sources
Parent(s)
$
Active Duty/BAS
$
$
Untaxed Pensions
$
$
Education Credits
$
$
IRA Deductions
$
$
Tax Exempt Interest
$
$
Untaxed IRA Distributions
$
$
Other Untaxed Income (please specify):
$
Please
INITIAL that you understand the following:
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, 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 by the scheduled
deadlines my classes may be dropped.
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,
sentenced to jail, or both.
Student Signature: ________________________________________________ Date: _________________
Parent’s Signature (if dependent): ____________________________________ Date: _________________
Student
(
& S
p
ouse
,
if a
pp
licable
)
: Parents
(
De
p
endent students onl
y)
Deferment Authorization Agreement
SIGNATURE
(
S
)
RE
UIRED
click to sign
signature
click to edit
click to sign
signature
click to edit
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