Gavilan Joint Community College Board Of Governors Fee Waiver Application (Page 2 of 2) in pdf

METHOD B ENROLLMENT FEE WAIVER

10. DEPENDENT STUDENT: How many persons are in your parent(s)/RDP household? (Include yourself, your parent(s)/RDP, and anyone

who lives with your parent(s)/RDP and receives more than 50% of their support from your parents/RDP, now and through June 30, 2009.)

_________

11. INDEPENDENT STUDENT: How many persons are in your household? (Include yourself, your spouse/RDP, and anyone who lives with

you and receives more than 50% of their support from you, now and through June 30, 2009.) ___________

12. 2007 Income Information

DEPENDENT STUDENT:

INDEPENDENT STUDENT:

PARENT(S)/ RDP

STUDENT ( & SPOUSE'S/ RDP)

INCOME

Adjusted Gross Income (If 2007 U.S. Income Tax Return was

filed, enter the amount from Form 1040, line 37; 1040A, line 21;

1040EZ, line 4).

All other income (Include ALL money received in 2007 that is not

included in line (a) above (such as TANF benefits, disability,

Social Security, child support).

TOTAL Income for 2007 (Sum of a + b)

The Financial Aid Office will review your income and let you know if you qualify for an ENROLLMENT FEE WAIVER under Method B. If

you do not qualify using this simple method, you should file a FAFSA.

SPECIAL CLASSIFICATIONS ENROLLMENT FEE WAIVERS

13. Do you have certification from the CA Department of Veterans Affairs that you are eligible for a dependent's fee waiver?

q Yes q No

Submit certification

14. Do you have certification from the National Guard Adjutant General that you are eligible for a dependent's fee waiver?

q Yes q No

Submit certification.

15. Are you eligible as a recipient of the Congressional Medal of Honor or as a child of a recipient?

q Yes q No

Submit documentation from the Department of Veterans Affairs.

16. Are you eligible as a dependent of a victim of the September 11, 2001, terrorist attack?

q Yes q No

Submit documentation from the CA Victim Compensation and Government Claims Board.

17. Are you eligible as a dependent of a deceased law enforcement/fire suppression personnel killed in the line of duty?

q Yes q No

Submit documentation from the public agency employer of record.

· If you answered "Yes" to any of the questions from 1317, you are eligible for an ENROLLMENT FEE WAIVER and perhaps other fee

waivers or adjustments. Sign the Certification below. Contact the Financial Aid Office if you have questions.

CERTIFICATION FOR ALL APPLICANTS: READ THIS STATEMENT AND SIGN BELOW

I hereby swear or affirm, under penalty of perjury, that all information on this form is true and complete to the best of my knowledge. If asked by an authorized

official, I agree to provide proof of this information, which may include a copy of my and my spouse/registered domestic partner and/or my

parent's/registered domestic partner’s 2007 U.S. Income Tax Return(s). I also realize that any false statement or failure to give proof when asked may be cause

for the denial, reduction, withdrawal, and/or repayment of my waiver. I authorize release of information regarding this application between the college, the college

district, and the Chancellor's Office of the California Community Colleges.

Applicant’s Signature

Date

Parent Signature (Dependent Students Only)

Date

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 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, domestic 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.

FOR OFFICE USE ONLY

q BOGFWA

q BOGFWB

q Special Classification

RDP

Not Eligible due to:

q Veteran

qNational Guard Dependent

q Student

q TANF/CalWORKs

Non CA resident