Fillable Independent Student Verification Worksheet (Page 2 of 2) in pdf

2007-2008 Independent Student Verification Worksheet (Continued)

B-3

Funds received for child support, other untaxed income (e.g., TANF/CALWORKs, SSI, Military Living Allowance) and any

other income not reported on a 2006 Federal tax return. (See Worksheets A & B of the Free Application for Federal Student

Aid.)

Source(s) of Untaxed Income

2006 Amount

C. Spouse’s Tax Forms and Income Information (if student is married)

C-1

Please submit a signed copy of his/her Federal income tax return (includes the 2006 IRS Forms 1040, 1040A, 1040EZ, a tax

return from Puerto Rico, or a foreign income tax return). If your spouse did not keep a copy of the tax return, request a copy

from the tax preparer or a copy of an Internal Revenue Service form that lists tax account information.



Check here if you are attaching a copy of your spouse’s signed tax return.



Check here if your spouse will not file and is not required to file a 2006 Federal Income Tax Return.

C-2

If your spouse did not file and is not required to file a 2006 Federal income tax return, list below your spouse’s employer(s)

and any income received in 2006, (use the W-2 form or other earnings statements, if available).

Employer(s)

2006 Amount

C-3

Funds received by your spouse for child support, other untaxed income (e.g., TANF/CALWORKs, SSI, Military Living

Allowance) and any other income not reported on a 2006 Federal tax return. (See Worksheets A & B of the Free Application

for Federal Student Aid.)

Source(s) of Untaxed Income

2006 Amount

D. Signatures

By signing this worksheet, I/we certify that all the information reported to qualify for federal student aid is complete and correct (if

married, spouse’s signature is optional).

WARNING: If you purposely give false or misleading information on this worksheet,

you may be fined, sentenced to jail, or both.

Signature of Applicant

Date

Signature of Applicant’s Spouse

Date

DO NOT MAIL THIS WORKSHEET TO YOUR APPLICATION PROCESSOR.

TAKE IT TO YOUR COLLEGE FINANCIAL AID OFFICE. DON’T FORGET TO SIGN YOUR TAX FORMS.

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.

210/ISVW (Rev. 06/20/07, rlq)