Instructions: REQUIRED DOCUMENTATION. Step 1: Collect and attach all required documentation. (See Required Documentation below.)

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1 Financial Aid Office PO Box 8106 San Luis Obispo, CA Print Clearly Last Name Telephone Number First Name Address Verification Worksheet - Dependent Student (V5) Your Free Application for Federal Student Aid (FAFSA) was selected for review in a process called verification. Federal regulations require us to confirm the information you reported on your FAFSA. To verify that you provided correct information, we will compare your FAFSA with the information on this worksheet and with any other required documents. If there are differences, your FAFSA information may need to be corrected. Instructions: Step 1: Collect and attach all required documentation. (See Required Documentation below.) Step 2: Complete this form. The student and one parent need to sign in the Certification section. Step 3: Submit this form to the Financial Aid Office by one of these methods: Submitting it in-person at the Financial Aid Office Scanning the form and ing it from your mycuesta account to: finaid@cuesta.edu Mailing the form to: Cuesta College Financial Aid, PO Box 8106, San Luis Obispo, CA REQUIRED DOCUMENTATION STUDENT DOCUMENTATION REQUIRED If the student filed taxes in 2014 (or was required to file taxes), please attach: 2014 IRS Tax Return Transcript o o To order by phone: o We cannot accept copies of your tax returns; it must be a tax return transcript issued by the IRS. o If you used the IRS Data Retrieval Tool successfully when completing your FAFSA online, we do not need your tax transcripts. If the student worked in 2014, but did not file taxes, please attach: Copies of ALL 2014 W-2 and/or 1099 forms for student If the student received SNAP (food stamp) benefits in 2013 or 2014, please attach proof. PARENT DOCUMENTATION REQUIRED If the parent(s) filed taxes in 2014 (or were required to file taxes), please attach: 2014 IRS Tax Return Transcript o o To order by phone: o We cannot accept copies of your tax returns; it must be a tax return transcript issued by the IRS. o If you used the IRS Data Retrieval Tool successfully when completing your FAFSA online, we do not need your tax transcripts. If the parent(s) worked in 2014, but did not file taxes, please attach: Copies of ALL 2014 W-2 and/or 1099 forms for parents If the parent(s) received SNAP (food stamp) benefits in 2013 or 2014, please attach proof.

2 Family Information 1. List all of the people in your parent(s) household in the table below. Include: Yourself; Your legal parents (biological or adoptive) even if you don t live with your parents. Note: you must include both of your legal parents if they are living together, regardless of their marital status or gender. If your parents are divorced or separated: a. Include the legal parent with whom you live or who provides more than half of the support you currently receive from parents. b. Include any stepparent married to your legal parent. c. If you live with neither parent and neither parent provides support, include the one with whom you most recently lived or from whom you received support. Your parent(s) other children if your parent(s) will provide more than half of their support from July 1, 2015, through June 30, 2016, or if the other children would be required to provide parental information if they were completing a FAFSA for Include children who meet either of these criteria, even if they do not live with your parent(s); AND Other people if they currently live with your parent(s) and your parent(s) provide more than half of their support and will continue to provide more than half of their support through June 30, Full Name Age Relationship If this person will be attending college at least half-time from July 1, 2015 to June 30, 2016, please write the name of the college here. Missy Jones (example) 18 sister Central University Self If you need more space, attach a separate page with your name and Student ID Number at the top. 2. Check the boxes next to the programs listed below if anyone listed in the table above received benefits from that program in 2013 or SSI Social Security Free or Reduced Price Lunch WIC TANF (Cash aid) Food Stamps (SNAP)* *If anyone received food stamps in 2013 or 2014, you must attach documentation of the receipt of those benefits. 2/5 DV5_16

3 Income Information 3. As of today, are either of your parents a dislocated worker? YES NO Dislocated workers are people who have been terminated / laid off or have recently received notice of termination; OR homemakers forced to return to the workforce because they no longer have financial support from their family 4. Did you receive any income from employment in 2014? STUDENT YES NO PARENT(S) YES NO 5. Did you file taxes for 2014 (or were required to file for 2014 but have not yet filed)? STUDENT YES NO See the Required Documentation section for requirements. PARENT(S) YES NO See the Required Documentation section for requirements. 6. Did you receive any income from employment in 2014 for which you didn t receive a W-2 form? STUDENT YES NO If yes, fill out the table below. PARENT(S) YES NO If yes, fill out the table below. Who worked in 2014 without receiving a W-2? Employer s Name Amount Earned in 2014 Robert Partridge (example) Suzy s Auto Body Shop (example) $2,000 (example) 7. Did your parents pay child support in 2014? YES NO If yes, complete table below for each child for whom child support was paid. Name of Person Who Paid Child Support Name of Person to Whom Child Support was Paid Name of Child for Whom Support Was Paid Total Amount Paid in 2014 Marty Jones (example) Chris Smith Terry Jones $6,000 Note: If we have reason to believe that the above information is not accurate, we may request the following: A copy of the separation agreement or divorce decree that shows the amount of child support to be provided; A statement from the individual receiving the child support certifying the amount of child support received; or Copies of the child support payment checks, money order receipts, or electronic payments having been made. 3/5 DV5_16

4 8. Provide documentation of your high school completion status. (Attach documentation to this form.) Mark the box of the documentation you are providing. You must provide one of the following documents that indicate your high school completion status when you will begin college in : If you are a high school graduate, please provide one of the following: A copy of your high school diploma A copy of your final official high school transcript that shows the date when the diploma was awarded. If you were homeschooled, please provide one of the following: If your state s law requires a homeschooled student to obtain a secondary school completion credential for homeschool (other than a high school diploma or its recognized equivalent), a copy of that credential. If your state s law does not require a homeschooled student to obtain a secondary school completion credential for homeschool (other than a high school diploma or its recognized equivalent), a transcript or the equivalent, signed by the student's parent or guardian, that lists the secondary school courses the student completed and documents the successful completion of a secondary school education in a homeschool setting. If you didn t graduate from high school and you were not homeschooled, please provide one of the following: A copy of your General Educational Development (GED) certificate or a GED transcript. A copy of your California High School Proficiency Exam (CHSPE) certificate or a CHSPE transcript. An academic transcript that indicates you have successfully completed at least a two-year program that is acceptable for full credit toward a bachelor s degree (e.g. an associate s degree). 9. Verify your identification Attach a legible photocopy of your valid government-issued photo identification (e.g. driver s license, state ID, passport). Sign the Statement of Educational Purpose in front of a Cuesta College financial aid employee. Note: If you are unable to appear in person at Cuesta College, you must sign in the presence of a notary public. Do NOT complete the Statement of Educational Purpose below unless you are in the presence of either a Cuesta College financial aid employee or a notary public. Statement of Educational Purpose I certify that I am the individual signing (Print Student s Name) this Statement of Educational Purpose and that the federal student financial assistance I may receive will only be used for educational purposes and to pay the cost of attending Cuesta College for WARNING: If you purposely give false or misleading information on this worksheet, you may be fined, be sentenced to jail, or both. Each person signing this worksheet certifies that all of the information reported on it is complete and correct. The student and one parent must sign and date. (Student s Signature) (Parent s Signature) Financial Aid Staff Witness Signature 4/5 DV5_16

5 Notary s Certificate of Acknowledgement (required only if you cannot sign in person at Cuesta College) State of City/County of On, before me,, (Notary s name) personally appeared,, and provided to me (Printed name of signer) on basis of satisfactory evidence of identification (Type of government-issued photo ID provided) to be the above-named person who signed the foregoing instrument. WITNESS my hand and official seal (Notary s signature) (seal) My commission expires on Certification We certify that any federal student aid the student receives will only be used to pay for education-related expenses during the award year. WARNING: If you purposely give false or misleading information on this worksheet, you may be fined, sentenced to jail, or both. Each person signing this worksheet certifies that all of the information reported on it is complete and correct. The student and one parent must sign and date. Student s Signature Date Parent s Signature (Required) Date Office Stamp 5/5 DV5_16