Fafsa Worksheet Page 2
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2CA DREAM Act Worksheet
The following items are necessary for the student to complete their California Dream Act in the pursuit of state assistance through grants, fee waivers, and
scholarships. The information on this page will require parent information if you are considered a Dependent Student. We encourage parents to assist their
students in this process. Copies of tax forms are recommended.
Last Name__________________________ Middle Initial_______ First Name_______________________ (Legal name)
1. Individual Taxpayer Identification Number (ITIN) or Deferred Action Social Security (none enter 000-00-000)
#:____________- __________-_____________.
2. Statewide Student Identification Number (SSID) (you will have a 10 digit # only if you attended CA public high school)
3. Citizenship Status (CIRCLE ONE):
US Citizen
Eligible Non-Citizen
Not a citizen or eligible noncitizen
Eligible Non- Citizen: A#________________________________ (also known as green card or MICA)
4. Parent Individual Taxpayer Identification Number (ITIN) or Social Security Card number (none enter 000-00-000)
SSN#:___________- _________-___________
SSN#:___________- _________-____________
5. Parent’s Marital Status: (CIRCLE ONE)
Married
Remarried
Single
Divorced
Separated
Widowed
Unmarried living together
6.
Date Married or Remarried/Single/Divorced or Separated/Widowed/Unmarried and both parents are living together
Month____________ Year____________
7. Parents’ Date of Birth:
Parent 1:_________/_________/__________ Parent 2:_________/_________/__________
INCOME AND ASSETS:
8. Student’s Federal Income Tax return from 2013 (if not yet filed, use 2012)
For 2013, have you Already (Circle One):
Completed
Will File Not going to file
Income earned from work: $________________ (W-2 forms)
Form Filed: IRS 1040 / IRS 1040A / IRS 1040EZ
9. Adjusted Gross Income $_______________
# of Exemptions___________ Federal Income Tax___________________
IRS 1040-line 37;1040A-line 21; or1040EZ-line 4
IRS 1040-6d;1040A-line 6d
IRS 1040 line 55;1040A-Line55; or 1040EZ-line 10
10. Parent’s Federal Income Tax return from 2013 (if not yet filed, use 2012)
For 2013, have you Already: Completed/Will File/Not going to file (Circle One)
Parent 1 Income earned from work: $_______________(W-2 forms)
Form Filed: IRS 1040 / IRS 1040A / IRS 1040EZ
Parent 2 Income earned from work: $_______________(W-2 forms)
Form Filed: IRS 1040 / IRS 1040A / IRS 1040EZ
11. Adjusted Gross Income $_______________
# of Exemptions_________
Federal Income Tax____________________
IRS 1040-line 37;1040A-line 21; or1040EZ-line 4
IRS 1040-6d;1040A-line 6d
IRS 1040 line 55;1040A-Line55; or 1040EZ-line 10
Records of Additional Financial information:
TANF/SNAP, Social Security, Veteran’s Benefits, or Military, or Clergy Allowances, Child support paid or received
Asset information:
Parent(s) Checking and Savings: $__________________
Student Checking and savings: $______________
Parent(s) Net worth of Investments: $ ________________
Student net worth of investments: $_____________
Parent(s) net worth of business and or investment farms $________
Student net worth of business and /or investment
Parent CA Dream Act Personal Identification Number PIN: _ _ _ _ (# will be assigned after completion of application)
NOTE: Make a list of Colleges or Universities student plans to attend
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Worksheet A - Residency Information Worksheet For Nonresidents/part-year Residents, Worksheet B - Income Allocation Worksheet For Nonresidents/part-year Residents, Worksheet C - Employee Apportionment Worksheet
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Parent category: Legal