Verification Worksheet
2700 Barstow Rd. Barstow, CA 92311
(760) 252-2411, x7205 Fax (760) 252-6748

Your FAFSA application has been selected for review in a process called “verification.” We are required by law to compare the information from your FAFSA application with the information provided on this form and with signed copies of your 2007 federal tax forms and your spouse’s or parents’ (if applicable). If there are differences between your FAFSA application and the documents you have submitted, corrections will be made.

We cannot process your financial aid until verification has been completed. Please provide required documents as soon as possible. Please print when filling out this form, complete all sections and sign the worksheet.

A. STUDENT INFORMATION

 
  
Last Name First Name M.I. Social Security Number
 
  
Address (Include apt #) Date of Birth
 
  
City State Zip Code Phone Number with area code
       
Are you or will you be attending another college this year? Yes No    
If yes, enter college’s name: ___________________________
    

What is your major: _________________________

    
Have you received foster youth services? Yes No      

B. DEPENDENCY STATUS

Were you born before January 1, 1985? Yes No
As of today, are you married? (Answer "Yes" if you are separated but not divorced.) Yes No
Do you have children who receive more than half of their support from you, or other dependents who live with you (other than your children and spouse) who receive more than half of their support from you, now and through June 30, 2009? Yes No
Are you an orphan or a ward of the court, or were you a ward of the court until your 18th birthday? Yes No
Are you a veteran of the U.S. Armed Forces? Yes No
Are you currently a member of the military? If yes, you must submit a current LES. Yes No

IF YOU ANSWERED “YES” TO AT LEAST ONE OF THE ABOVE QUESTIONS, YOU ARE INDEPENDENT. IF YOU ANSWERED “NO” TO ALL QUESTIONS, YOU ARE DEPENDENT. PLEASE COMPLETE THE REMAINDER OF PACKET USING THIS DEPENDENCY STATUS.

C. PLEASE READ AND INITIAL THE STATEMENTS BELOW

I certify that the above information is true and correct. If this form has been completed with intent to receive federal financial aid on the basis of false and/or incomplete information, I understand that I am subject to denial of aid and possible federal prosecution. ______

Students receiving financial aid are expected to maintain satisfactory academic progress. Students must complete 67% of all classes attempted with a cumulative grade point average of 2.0 or above. _____

Students must complete educational goals prior to 150% of the published length of their selected program. Students working towards an Associate’s degree will be dismissed from financial aid after attempting 90 units. _____

Students who do not maintain satisfactory academic progress for two semesters will be dismissed from financial aid._____

Students receiving financial aid who withdraw from classes within the first 60% of the term or receive all F’s (IF’s or FW’s) or a combination of F’s and withdrawals/drops may be in repayment status for Title IV funds. _____

I understand that if I receive financial aid from more than one school during the same term I will be in overpayment status and may have to repay a portion or all of my grants. Furthermore, I understand that if I intend to transfer to another school during the 08-09 aid year and plan to receive financial aid at the other institution, I must notify the Barstow Community College Financial Aid Office of my intent._____

I understand that if for any reason I should become ineligible for financial aid, the fees that were paid by financial aid become a debt to the college that I must pay. ____

I understand that current charges for tuition and fees and minor charges (less than $100) will be deducted automatically from my financial aid check. ____

I authorize BCC to deduct from my financial aid check other outstanding charges I have incurred until I rescind
this statement in writing. Yes No

D. FAMILY INFORMATION

Independent Students: List the people in your household. Include: (1) Yourself, your spouse if married (2) your children, if you provide more than half of their support from July 1, 2008 through June 30, 2009; and (3) any other people if they now live with you, and you provided more than half of their support and will continue to provide more than half of their support from July 1, 2008 through June 30, 2009.

Write the names of all household members. Also write in the name of the college for any household member who will be attending college at least half time between July 1, 2008 and June 30, 2009, and will be enrolled in a degree diploma or certificate program. If you need more space, attach a separate piece of paper.

Dependent Students: List the people in your parents’ household. Include: (1) Yourself and your parent(s), including stepparent (these are the parents you are currently living with or would live with if you were not in school); (2) Your parents’ other children (even if they don’t live with your parents), if (a) your parents provide more than half of their support from July 1, 2008 through June 30, 2009, or (b) the children would be required to provide parental information when applying for Federal student aid; and (3) Other people if they now live with your parents, and your parents provide, and will continue to provide, more than half of their support from July 1, 2008 through June 30, 2009.

Write the names of all household members. Also write in the name of the college for any household member (excluding your parents), who will be attending college at least half time between July 1, 2008 and June 30, 2009, and will be enrolled in a degree diploma or certificate program. If you need more space, attach a separate piece of paper.

Full Name Age Relationship College
Example: Martha Jones 24 Wife City College
    Self Barstow College
       
       
       
       
       
       

E. STUDENT AND SPOUSE/PARENT’S INCOME INFORMATION

Both tax filers and non-tax filers must list any untaxed income received and income adjustments in 2007. Be sure to enter zeros if no funds were received or adjusted. Failure to complete this section will delay the processing of your financial aid.

Student/Spouse

Calendar Year 2007


Parent(s)

$

FAFSA WORKSHEET A: (untaxed income)

$

Welfare benefits, including Temporary Assistance for Needy Families (TANF). Don’t include food stamps or subsidized housing.

$

Social Security benefits received that were not taxed, for all household members.

$
$ Earned income credit from IRS Form 1040 line 66a; 1040 A line 40a; or 1040EZ line 8a. $
$ Additional child tax credit from IRS Form 1040 line 68 or 1040 A line 41. $

$

FAFSA WORKSHEET B: (untaxed income)

$

Payments to tax-deferred pensions and savings plans (paid directly or withheld from earnings) including amounts reported on W-2 Form Boxes 12a through 12d, codes D, E, F, G, H, and S.

$ IRA deductions and payments to self employed SEP, SIMPLE, and Keogh and other qualified plans from IRS Form 1040 line 28 plus line 32 or 1040 line 17. $
$ Tax exempt interest income from IRS Form 1040 line 8b or 1040A line 8b. $
$ Foreign income inclusion from IRS for 2555 line 45 or 2555EZ line 18. $

$

Untaxed portions of IRA distributions from IRS Form1040 lines 15a minus 15b or 1040A lines 11a minus 11b. Exclude rollovers. If negative, enter zero here.

$

$

Untaxed portions of pensions from IRS Form 1040 lines 16a minus 16b or 1040A lines 12a minus 12b. Exclude rollovers. If negative enter zero here.

$

$

Credit for federal tax on special fuels from IRS Form 4136 line 18 (nonfarmers only).

$

$

Child support received for all children. Don’t include foster care or adoption payments.

$
$ * Housing, food, and other living allowances paid to members of the military, clergy, and others (including cash payments and cash value of benefits). * $
$ Veterans’ non-education benefits such as Disability, Death Pension, or Dependency & Indemnity Compensation (DIC), and/or VA Educational Work-Study allowances. $
$ Any other untaxed income and benefits not reported elsewhere, such as Workers’ Compensation, untaxed portions of Railroad Retirement Benefits, Black Lung Benefits, disability, etc. Tax filers only: report combat pay not included in adjusted gross income. (Don’t include student aid, Workforce Investment Act educational benefits, combat pay if you are not a tax filer, or benefits from flexible spending arrangements such as cafeteria plans.) $

$

Cash or any money paid on your behalf, such as bills, not reported elsewhere on this form.

$

$

FAFSA WORKSHEET C: (income adjustments)

$

Child support paid because of divorce or separation or as a result of a legal requirement. Do not include support for children in your (or your parents’) household.

$

Taxable earnings from Federal Work-Study or other need-based employment portions of fellowships and assistantships.

$

$

Student grant, scholarship, fellowship or assistantship aid, including AmeriCorps benefits, that was reported to the IRS in your (or your parents’) adjusted gross income.

$
$ Education Credits (Hope and Lifetime Learning Tax credits) from IRS Form 1040 –line 49 or 1040A-line 31. $

F. SIGNATURES

By signing, I (we) certify that all information reported on this worksheet is complete and correct. At least one parent (if student is dependent) must also sign. Warning: If you purposely give false or misleading information on this worksheet, you may be fined, sentenced to jail, or both.

Student’s Signature  
Date  
Parent Signature
(if applicable)		  
Date  

Please return to:

Barstow College
Financial Aid Office
2700 Barstow Road
Barstow, CA 92311