UCSC Student s Last Name. q W-2 and/or 1099 Forms Be sure to include all W-2 and/or 1099 forms received from your employer(s), if applicable.

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1 FINANCIAL AID AND SCHOLARSHIP OFFICE uc santa cruz Dependent Student Verification Packet UCSC Student s ID /Account You have been selected by the UC Santa Cruz Financial Aid and Scholarship Office for a process called verification for the academic year. In this process, we will compare the information you provided on the FAFSA with signed copies of your 2010 IRS federal income tax returns, schedules and attachments, W-2 s, and other information you provide in this packet. If necessary, we will make corrections and update your FAFSA. This packet must be received in the Financial Aid and Scholarship Office no later than June 1, 2011 to meet the priority deadline. Submit the completed and signed forms to: UC Santa Cruz Financial Aid and Scholarship Office 205 Hahn Student Services Building 1156 High Street Santa Cruz, CA To protect your personal information, do not send completed forms via . If you have questions about the information contained in this packet, please contact us at Use the checklist below before mailing your information to avoid delays: q IRS Federal Tax Returns (Do not send your state return.) Attach and sign copies of your ,1040A, or 1040EZ IRS federal tax return along with all schedules and attachments include all pages. Federal IRS tax return extensions are generally not accepted. Call the Financial Aid and Scholarship Office for more information. q W-2 and/or 1099 Forms Be sure to include all W-2 and/or 1099 forms received from your employer(s), if applicable. q Signatures Signatures are required on the tax return and the certification found on the last page of this packet. q Answer All Questions You must provide an answer to every question. DO NOT LEAVE BLANKS. If something does not apply to you, respond using N/A (not applicable) or a 0 (zero). A blank answer will mean the information is incomplete and you will be asked to complete a new packet which may jeopardize your eligibility for aid. IMPORTANT NOTE FOR NEW S ADMITTED FALL 2011: Submit requested forms by April 15th to receive an aid offer prior to the Admissions Statement of Intent to Register (SIR) deadline. The SIR deadline is May 1st for new freshmen and June 1st for transfer students. Page 1 of 5 You must COMPLETE all PAges of this PACkET F2DPKT

2 FINANCIAL AID AND SCHOLARSHIP OFFICE uc santa cruz Dependent Student Verification Packet UCSC Student s ID /Account 1. Print the student s name and ID/account number clearly at the top of all pages of this packet. 2. The parent and student who provided the FAFSA information must complete and sign the Certification on page The parent and student must answer all questions. IF THE ANSWER IS ZERO, OR IS NOT APPLICABLE, WRITE IN A O. DO NOT LEAVE BLANKS. Student living arrangements during the academic year (check one): q On Campus q Off Campus q With parent(s) q Undecided Federal Tax RETURNS and INCOME INFORMATION q A complete, signed copy of my 2010 IRS federal income tax return is attached (including schedules and attachments) q I will not file a 2010 IRS federal income tax return q Wages earned during 2010 from work $ q Net business income $ q Do you own and control more than 50% of a business with over 100 employees q yes q A complete, signed copy of my 2010 IRS federal income tax return is attached (including schedules and attachments) q I will not file a 2010 IRS federal income tax return q Wages earned during 2010 from work by $ mother/stepmother $ father/stepfather q Net business income earned by $ mother/stepmother $ father/stepfather q Do you own and control more than 50% of a business with over 100 employees q yes other INCOME INFORMATION 1. Child support received for any of your children. Don t include foster care or adoption payments. $ N/A 2. Housing, food, and other living allowances paid to members of the military, clergy and others (including cash payments and cash value of benefits). Don t include the value of on-base military housing or the value of a basic military allowance for housing. 3. Veterans noneducation benefits, such as Disability, Death Pension, or Dependency & Indemnity Compensation (DIC) and/or VA Educational Work-Study allowances. 4. Other untaxed income not reported such as workers compensation, disability, etc. Do not include student aid, earned income credit, additional child tax credit, welfare payments, untaxed Social Security Benefits, Supplemental Security Income, Workforce Investment Act educational benefits, combat pay (if you are not a tax filer), benefits from special spending arrangements (e.g. cafeteria plans), foreign income exclusion, or credit for federal tax on special fuels. $ 5. Money received or paid on your behalf (e.g. bills) not reported elsewhere on this form. N/A Page 2 of 5 You must COMPLETE all PAges of this PACkET F2DPKT

3 other Income Information continued 6. Child support paid because of divorce or separation or as a result of a legal requirement. Don t include support for children in your household. List names N/A 7. Taxable earnings from need-based employment programs, such as Federal Work-Study and need-based employment portions of fellowships and assistantships. 8. Taxable student grant and scholarship aid reported to the IRS in your adjusted gross income. Includes AmeriCorps benefits (awards, living allowances and interest accrual payments), as well as grant and scholarship portions of fellowships and assistantships. 9. Combat pay or special combat pay. Only enter the amount that was taxable and included in your adjusted gross income. Do not enter untaxed combat pay. 10. Earnings from work under a cooperative education program offered by a college. N/A Savings, Investments and Other Assets on the Date the FAFSA was Filed Note: Investments do not include the home you live in, the value of life insurance, retirement plans (pension funds, annuities, non-education IRA s, Keogh plans, etc.) Cash, Savings, and Checking Accounts Trust Funds UGMA/UTMA Accounts Money Market Mutual Funds Certificates of Deposit Stock Stock Options Bonds, other securities Installment and Land Sale Contracts Educational Benefits Educational Savings Accounts 529 College Savings Accounts for all family members Refund Value of 529 Prepaid Tuition Plans Other (specify) Page 3 of 5 You must complete all pages of this packet F2DPKT

4 Parent Real ESTATE INVESTMENTS Does your parent own real estate investments excluding the home you live in? q Yes q No If yes, provide details below. Complete this information for all real estate you own other than your primary residence such as mobile homes, condos, duplexes, rental property, land, summer homes, etc as of the date the FAFSA was filed. Property 1 (Do not report the home you live in): Current Market Value* $ Mortgage Balance $ Purchase Price $ Acquired Property 2 (Do not report the home you live in): Current Market Value* $ Mortgage Balance $ Purchase Price $ Acquired Property 3 (Do not report the home you live in): Current Market Value* $ Mortgage Balance $ Purchase Price $ Acquired Property 4 (Do not report the home you live in): Current Market Value* $ Mortgage Balance $ Purchase Price $ Acquired Complete this section if you, the parent, RENTED OUT A PORTION OF THE HOME YOU LIVE IN that meets the following criteria: the rental unit has its own entry and includes a kitchen and bath. The portion of your home that generates rental income is considered an asset and must be reported as an investment net worth on the FAFSA. Complete the following information about the home you live in: Current Market Value* $ Mortgage Balance $ Purchase Price $ Acquired Rental Square Footage + Home Square Footage = Total Dwelling Square Footage *on the date you filed the FAFSA Student Real ESTATE INVESTMENTS Does the student own any real estate investment property q yes For Office Use Only Total Current Market Value Total Mortgage Balance INW Page 4 of 5 You must COMPLETE all PAges of this PACkET F2DPKT

5 Household Information List the people in your household. Include yourself, your spouse, and your children, if (a) you provide more than half of their support or (b) the children would be required to provide parental information when applying for Federal Student Aid. List any other people if they now live with you and you provide more than half of their support and will continue to provide more than half of their support from July 1, 2011 through June 30, If you have additional people to list, attach a separate sheet of paper with the required information. Full Name of Family Member in Household Date of Birth MM/DD/YY Age Relationship to Student Social Security Number Name of College (if attending in ) For those enrolled in college for , list current degree objective.* Father/ Stepfather Mother/ Stepmother UCSC Student self UCSC Other Members in Household *AA, BA, BS, Certificate, MA, PhD, MD, DDS In 2009 or 2010, did you or anyone in your household receive benefits from any of the Federal programs listed? Mark all programs that apply: q Supplemental Security Income q Food Stamps (SNAP) q Free or reduced price lunch q TANF q WIC In 2009 or 2010, did you receive federal low-income housing such as HUD or Section 8? q Yes q No CERTIFICATION I hereby declare that all information reported on this document is true, complete, and accurate to the best of my knowledge. I understand that any false statement or misrepresentation will be cause for denial, reduction, cancellation and/or repayment of financial aid. I understand that verifications of enrollment will be required if family members are listed in college. This document must be received no later than June 1, 2011 to meet the priority deadline for all types of financial aid. Parent, please report your marital status as of the date you submitted the Fafsa application. Please provide the month and year you were married, separated, divorced, widowed, or a California Registered Domestic Partner in the box next to your selection. Single Divorced Separated Married/Remarried Widowed California Registered Domestic Partner Parent Name Parent Signature Date / / please print Parent Phone ( ) Parent Address Student Signature Date Return to: UC Santa Cruz Financial Aid and Scholarship Office, 205 Hahn Student Services Building, 1156 High Street, Santa Cruz, CA Phone: (831) Web: financialaid.ucsc.edu. For your protection and security, please do not forms. Page 5 of 5 You must complete all pages of this PACket F2DPKT

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