THE FOLLOWING DOCUMENTS MUST BE SUBMITTED WITH THE INCOME ADJUSTMENT REQUEST FORM:

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1 Napa Valley College INCOME ADJUSTMENT REQUEST INDEPENDENT Students Application Deadline: March 29, 2019 July 2018 Police Academy: Contact the Financial Aid Office for possible early submission date. This Income Adjustment Request form may be used by you and your family to report unusual circumstances that affect your ability to pay for your education at Napa Valley College (NVC). These circumstances can be conditions that have reduced your current income or extraordinary expenses that reduced your disposable income. Please complete all of the required information appropriate to your circumstances. Incomplete forms will be denied and documents will not be returned to you. Be sure to submit supporting documents with this form. If your income reduction is not measurable or appears inconsistent, your request will be denied. Likewise, expenses for consumer goods and lifestyle choices (such as credit cards or car payments) will not be supported with additional financial aid resources. Submit a separate form for each family member who is requesting an adjustment of income. 1. Before you may submit this form, you must: a. File a Free Application for Federal Student Aid (FAFSA) listing Napa Valley College as a school of attendance; and b. Submit all documents required by the NVC Financial Aid/EOPS Office; and c. Be determined eligible to receive federal student aid at NVC. 2. Complete the Income Adjustment Request only if your (and/or your spouse s) income will be lower in 2018 than it was in 2016 or you have unusual expenses that reduced your available income. Do not make a request for a situation that has not already happened. 3. Include the documents listed below with your request. If you are separated from your spouse or the loss of income is due to the death of your spouse, include only your income information. 4. Submit the completed Income Adjustment Request together with all required documents to the Financial Aid/EOPS Office by no later than March 29, DO NOT SUBMIT DOCUMENTS SEPARATELY. 5. Income adjustment requests take an average of 6-8 weeks for processing. You will be notified of the results of your request by mail. Incomplete forms will be denied and documents will not be returned to you. It is the student s responsibility to make copies of their documents, prior to submitting them to the Financial Aid Office Income Verification Documents THE FOLLOWING DOCUMENTS MUST BE SUBMITTED WITH THE INCOME ADJUSTMENT REQUEST FORM: A copy of your (and your spouse s, if applicable) 2016 IRS Tax Return Transcript, if you did not complete the IRS Data Retrieval Tool Process in your FAFSA application (or modified data after completing the retrieval process), W-2 s, 1099 s, and other income statements. NOTE: A copy of your (and your spouse s, if applicable) 2016 Federal Income Tax Return is also required if you (and/or your spouse if applicable) had a pension rollover during the 2016 tax year Independent Verification Documents (forms listed below can be found on NVC s Financial Aid forms page). Verification of Taxable Income-Student Verification of Household-Independent Agency certification verifying other taxable 2016 income, such as unemployment benefits, retirement benefits, pensions, etc. that are not listed on the IRS Tax Return Transcript. Agency certification verifying untaxed 2016 income, such as disability, worker s compensation, etc. that are not listed on the IRS Tax Return Transcript. If the documents required above have already been submitted due to a request from the Financial Aid/EOPS Office, you do not have to submit them a second time. If you are unsure, please submit all the required documents.

2 Current 2018 Income Verification Documents Not all of the documents listed may apply to your situation. However, you must provide adequate documentation to support your request so that the Financial Aid/EOPS Office can make a determination concerning your situation. If you do not provide sufficient information to support your request, your request will be denied and documents will not be returned to you. It is the student s responsibility to make copies of their documents, prior to submitting them to the Financial Aid Office. Current (as of the date you submit this request) pay stubs showing 2018 year-to-date earnings from each employer. Final pay stubs, if applicable, which list 2018 year-to-date earnings. Write the last date worked for the employer on the pay stub. Signed statements, on official letterhead from all employers, for 2018 expected earnings through 12/31/2018. Signed statement, on official letterhead, from past employers verifying earnings for Divorce agreement designating family and child support, statement from the county Family Support Office, or signed statement from the person paying the support, to verify 2018 child support that has been or will be received. Agency statements of 2018 year-to-date and expected benefits for taxable social security, retirement, disability, worker s compensation, unemployment, etc. If benefits have been discontinued, an agency statement showing date benefits were stopped is also required. Other documents to verify income and benefits that have been or will be received during 2018 such as: Employer statement of reduced work hours. Employer or Employment Development Department statement verifying loss of employment. Any other documents to clarify your situation. For Income Adjustment requests submitted after November 30, 2018, you must wait to file your 2018 Federal Tax Return and submit a copy of your 2018 IRS Tax Return Transcript and W-2 s with your request! AN INCOMPLETE INCOME ADJUSTMENT REQUEST WILL BE DENIED AND WILL NOT BE RETURNED TO YOU. STUDENTS SHOULD KEEP A COPY OF ALL DOCUMENTS SUBMITTED. If you have questions concerning the Income Adjustment Request, you may contact the Financial Aid/EOPS Office by phone at (707) or come to the Financial Aid Office to schedule an appointment. Submit ALL FORMS AND DOCUMENTS TOGETHER to: Napa Valley College Financial Aid/EOPS Office 2277 Napa-Vallejo Hwy, Rm. #1132 Napa, CA Or submit all documents by FAXING to: (707) Keep these instructions for your reference.

3 Napa Valley College INCOME ADJUSTMENT REQUEST INDEPENDENT Students Submission Deadline: March 29, 2019 Student Name: First MI Last Student ID SECTION 1: LOSS OF INCOME If you or your family had a reduction of income, please identify whom the loss is for by placing a check in the space provided under the appropriate reason(s) for this change, and indicate the date that this change occurred. If you had no loss of income, skip to Section 2. A. Loss or Reduction of Employment or Wages Student Change Date Spouse Change Date B. Loss of Unemployment Compensation Student Change Date C. Loss of Untaxed Income or Benefits Student Change Date Type(s) of benefit lost: Spouse Change Date Spouse Change Date D. Marriage/Separation or Divorce You are a student who has already applied for Federal Student Aid, but since that time, you are now married. Please submit a copy of your marriage certificate and a copy of your spouse s 2016 IRS Tax Return Transcript. Date of Marriage: You were a married student who has already applied for Federal Student aid, but since that time, you separated or divorced. Write in the date that you separated or divorced: Separation Date: Divorce Date: E. Death of Spouse You are a married student that has already applied for Federal Student aid, but since that time, your spouse has died. F. Other Income Reduction If the reason for your income reduction was not listed above, state the reason here:

4 SECTION 2: UNUSUAL EXPENSES Check all applicable items and answer the questions that apply to you and your family. You must submit verification of unusual expenses. If you had no unusual expenses, skip to Section 3. A. Unusual Medical and Dental Expenses Amount paid for medical/dental insurance (do not include employer s contribution) in in Amount paid for medical/dental expenses not covered by insurance? In in B. Elementary and Secondary Tuition for List the amount of elementary and/or secondary school tuition you will pay for your dependent children to attend school during the academic year. Do not include college tuition or amounts covered by scholarships or waivers. Submit documents to verify tuition for each child. Child s Name Age Name of School Amount of Tuition C. Other Unusual Expenses List the amount of unusual debts or expenses for which you or your spouse are currently making a monthly payment. Do not list debt for discretionary purchases or services (such as car payments or credit cards). Submit documents verifying debt. Type of Debt Amount Owed Monthly Payments Reason for this debt or expense (be specific):

5 SECTION 3: EXPLANATION OF INCOME REDUCTION AND/OR EXPENSES (required) A. Please explain in detail the reason(s) for your request. Be specific about the circumstances regarding your income reduction or unusual expenses. Please attach additional sheets if necessary. B. Please explain in detail your current financial situation and living arrangements.

6 PLEASE COMPLETE ALL SECTIONS C. Please list the value of your current assets. Do not include retirement accounts. All sections must be completed. Student Spouse (if different) Cash/Checking/Savings Value Investments/Real Estate Value Business or Farm Value Other D. Please list your Expected 2018 Taxable and Non-Taxable Income and Benefits (submit agency verification of current benefits). Student Spouse 2018 Expected Income Earned from Work 2018 Unemployment Compensation 2018 Other Taxable Income (including interest, dividends, alimony, royalties, business income, pensions, retirement benefits, etc.) 2018 Child Support Received 2018 Other Untaxed Income and Benefits (disability, Worker s Comp, Veterans Non-Educational Benefits, etc.) Do not include CalWORKS, TANF, SSI, or untaxed Social Security Benefits. E. Other Information you would like us to consider: The student and anyone who is providing information must sign this certification. CERTIFICATION: I certify that the information I/we have provided is true and correct to the best of my knowledge. I understand that if the information I have provided is incomplete or false, financial aid could be delayed or denied. Student s Signature Date Spouse s Signature Date Student s ID