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Dependent Verification Worksheet

This document is a dependent verification worksheet for a student applying for financial aid at California State University, Los Angeles. It requests information to verify the student's dependency status and financial information reported on their FAFSA. This includes household size, tax filing status, income sources, and employment details for both the student and their parents. The student and at least one parent must complete and sign the form to certify the information is accurate before submitting it to the financial aid office.

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mvalenc3
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54 views

Dependent Verification Worksheet

This document is a dependent verification worksheet for a student applying for financial aid at California State University, Los Angeles. It requests information to verify the student's dependency status and financial information reported on their FAFSA. This includes household size, tax filing status, income sources, and employment details for both the student and their parents. The student and at least one parent must complete and sign the form to certify the information is accurate before submitting it to the financial aid office.

Uploaded by

mvalenc3
Copyright
© Attribution Non-Commercial (BY-NC)
Available Formats
Download as PDF, TXT or read online on Scribd
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Center for Student Financial Aid

California State University, Los Angeles


5151 State University Drive, SA 124 Los Angeles, CA 90032-8402 Phone: (323) 343-6260 Fax: (323) 343-3166
For office use only:

2012-2013
DEP_VER 02/12

2012-2013 Dependent Verification Worksheet


Your application was selected for review in a process called Verification. The Financial Aid Office will compare your Free Application for Federal Student Aid (FAFSA) with the information on this worksheet and any other required documents. If there are any differences, your FAFSA information may need to be corrected. Please keep in mind that incomplete forms will create a delay in processing. Instructions: You and at least one parent must complete and sign this worksheet. Submit the worksheet and any required documents to the Center for Student Financial Aid.

A. Student Information

Last Name Address (include apt. no.) City

First Name

M.I.

CIN Date of birth

State

ZIP code

Phone number (include area code)

B. Dependent Students Family Information


List the people in your parent(s) household. Include: Yourself and your parent(s) (including a stepparent) even if you do not live with your parent(s). Your parent(s) other children if your parent(s) will provide more than half of their support from July 1, 2012 through June 30, 2013; OR, if the other children would be required to provide parental information if they were completing a FAFSA for 20122013. Include children who meet either of these standards, even if they do not live with your parent(s). Other people if they now live with your parent(s) and your parent(s) provide more than half or their support and will continue to provide more than half of their support through June 30, 2013. Include the names all household members that meet the definition above in the space(s) below. Also, include the name of the college for any household member (excluding your parents) who will be enrolled at least half-time (6 units) in a degree, diploma, or certificate program at a postsecondary educational institution any time between July 1, 2012 and June 30, 2013. Attach a separate page if needed. Full Name Martha Jones (example) Age 24 Relationship Sister Self College California State University, Los Angeles Will be Enrolled at Least Half-Time Yes

Student Name:

CIN:

C. Students Income Information to be verified


1. TAX RETURN FILERS Complete this section if you filed or will file a 2011Federal Income Tax Return with the IRS. The best way to verify income is by using the IRS Data Retrieval Tool that is part of the FAFSA on the web www.fafsa.gov. It takes up to 2-weeks for IRS income information to be available for electronic tax filers and up to 8-weeks for paper IRS tax return filers. Check the box that applies: Check here if you have used the IRS Data Retrieval Tool in the FAFSA on the Web to retrieve and transfer your 2011 IRS income information onto your FAFSA. The Financial Aid Office will use the transferred information for the verification process. Check here if you are unable to (OR) choose not to use the IRS Data Retrieval Tool in the FAFSA on the Web and you are submitting a 2011 IRS Tax Return Transcript with this worksheet. To obtain an IRS tax return transcript visit www.IRS.gov and select the order a Return or Account Transcript link. Or call 1 (800) 908-9946. Be sure to request the IRS Tax Return transcript and not the IRS Tax Account transcript.

2.

AMENDED TAX RETURN FILERS: Select this box if you changed or corrected your federal income tax return originally filed with the IRS. If yes, you must submit both items below: IRS Tax Return Transcript (AND) IRS Tax Account Transcript

3.

NON-TAX FILERS Complete this section if you will not file and were not required to file a 2011 income tax return with the IRS. Check the box that applies: Check here if you were not employed and had no income from work during 2011. Check here if you were employed in 2011 and list below the name of all employers and the amount earned from work from each employer. Attach all copies of W-2 forms issued by your employers. List every employer even if they did not issue an IRS W-2 form. If more space is needed, attached a separate page.

Employers Name Suzys Auto Body Shop (example)

2011 Amount Earned $2,000.00 (example)

IRS W-2 Attached? Yes (example)

(Continued on page 3 for parents) 2

Student Name:

CIN:

D. Parents Income Information to be verified Note: If two parents were reported in Section B of this worksheet, the instructions and certifications below refer and apply to both parents.
1. TAX RETURN FILERS Complete this section if you filed or will file a 2011Federal Income Tax Return with the IRS. The best way to verify income is by using the IRS Data Retrieval Tool that is part of the FAFSA on the web www.fafsa.gov. It takes up to 2-weeks for IRS income information to be available for electronic tax filers and up to 8-weeks for paper IRS tax return filers. Check the box that applies: Check here if you have used the IRS Data Retrieval Tool in the FAFSA on the Web to retrieve and transfer your 2011 IRS income information onto your FAFSA. The Financial Aid Office will use the transferred information for the verification process. Check here if you are unable to (OR) choose not to use the IRS Data Retrieval Tool in the FAFSA on the Web and you are submitting a 2011 IRS Tax Return Transcript with this worksheet. To obtain an IRS tax return transcript visit www.IRS.gov and select the order a Return or Account Transcript link. Or call 1 (800) 908-9946. Be sure to request the IRS Tax Return transcript and not the IRS Tax Account transcript.

2.

AMENDED TAX RETURN FILERS: Select this box if you changed or corrected your federal income tax return originally filed with the IRS. If yes, you must submit both items below: IRS Tax Return Transcript (AND) IRS Tax Account Transcript

3.

NON-TAX FILERS Complete this section if you will not file and were not required to file a 2011 income tax return with the IRS. Check the box that applies: Check here if you were not employed and had no income from work during 2011. Check here if you were employed in 2011 and list below the name of all employers and the amount earned from work from each employer. Attach all copies of W-2 forms issued by your employers. List every employer even if they did not issue an IRS W-2 form. If more space is needed, attached a separate page.

Employers Name Suzys Auto Body Shop (example)

2011 Amount Earned $2,000.00 (example)

IRS W-2 Attached? Yes (example)

E. Please Sign and Date Below


By signing this worksheet, we certify that all the information reported on this worksheet is complete and correct. The student and one parent must sign and date.
Students Date
WARNING: If you purposely give false or misleading information on this worksheet, you may be fined, be sentenced to jail, or both.

Parents

Date

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