Fillable Form 20192020: V1 TheU.S.Dept.ofEducationselectedyourapplicationforreviewinaprocesscalledVerification.Inthisprocess,weare (CUNY Kingsborough Community College)

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Form 20192020: V1 TheU.S.Dept.ofEducationselectedyourapplicationforreviewinaprocesscalledVerification.Inthisprocess,weare (CUNY Kingsborough Community College)

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
2019‐2020
TheU.S.Dept.ofEducationselectedyourapplicationforreviewinaprocesscalled“Verification.”Inthisprocess,weare
requiredbylawtocomparetheinformationfromyourapplicationwiththeinformationprovidedonthisformandall
requestedfinancialdocumentation.Correctionsmaybedeemednecessary.Wecannotprocessyourfinancialaiduntil
verificationhasbeencompleted,sopleaseprovidetherequireddocumentsassoonaspossible.
SelectedFor VerificationTrackingFlag VerificationTrackingGroup FilloutSection
V1
StandardVerification
A,B,C,D,F,&G
V4
CustomVerificationGroup
A,D,E,F&G
V5
AggregateVerificationGroup
A,B,C,D,E,F&G
A.StudentInformation
XXX‐XX‐
LastNameFirstNameSocialSecurityNumberCUNYFIRSTID#
Address(includeapt.#)CityStateZipCode
DateofBirthEmailAddressPhoneNumber(IncludeAreaCode)
B.FamilyInformation
DependentStudent:
Yourself,evenifyoudon’tlivewithyourparents
Yourparents
Yourparents’otherchildren(eveniftheydonotlivewith
yourparents)ifyourparentswillprovidemorethanhalf
oftheirsupportbetweenJuly1,2019andJune30,2020,
Otherpeopleiftheynowlivewithyourparents,your
parentsprovidemorethanhalfoftheirsupportandyour
parentswillcontinuetoprovidemorethanhalfoftheir
supportbetweenJuly1,2019andJune30,2020.
IndependentStudent
Yourself(andyourspouse),
Yourchildren,ifyouwillprovidemorethanhalfoftheir
supportbetweenJuly1,2019andJune30,2020,evenif
theydonotlivewithyou,and
Otherpeopleiftheynowlivewithyou,youprovidemore
thanhalfoftheirsupportandyouwillcontinueto
providemorethanhalfoftheirsupportbetweenJuly1,
2019andJune30,2020

FullName Age Relationship
NameofattendingCollegein
2019‐2020
WillbeEnrolledatleasthalf
timefor2019‐2020
Myself
KingsboroughCommunityCollege
Yes
 YesNo
 YesNo
 YesNo
 YesNo
 YesNo
 YesNo
 YesNo
ForAdministrativeUseOnly
TypeGovernmentIssuedID:_________________________
GovernmentIssuedID#__________________________
NameofHighSchool__________________________
GraduationDate__________________________
C. TaxformsandIncomeInformation
Ifyoudidnotfileandarenotrequiredtofilea2017Federalincometaxreturn,listbelowyouremployer(s)andanyincomereceived
in2017(
AttachyourFormsW‐2or1099fromallsourcesofearnedincome).Pleasecheckoffonebox.

Didnot
haveany
income
DidnotFileTaxes
for2017(Attach
Verificationof
Non‐Filer)
FiledTaxesfor2017,
butdidnotuseIRS
DataRetrieval(Attach
TaxReturnTranscript)
UsedIRS
Data
retrieval
NameofEmployer Wages
Student

 
Spouse
 
Parent#1
 
Parent#2
 
D. AdditionalInformation
In2017or2018didanyoneinyourhouseholdreceiveanyofthefollowing?(Ifyoudonotcheckanyboxes,we
assumenothingwasreceived)
75/97 SSI/Medicaid
79/101 WIC
76/98 SNAP(FoodStamp)
84
Parent(s)DislocatedWorker
77/99 Free/ReducedLunch
102
StudentDislocatedWorker
78/100 TANF
Didnotreceiveany
E. StatementofEducationalPurpose
IcertifythatI,____________________________________(PrintStudent’sName)amtheindividualsigningthis
StatementofEducationalPurposeandthatthefederalstudentfinancialassistanceImayreceivewillonlybeusedfor
educationalpurposestopaythecostofattendingKingsboroughCommunityCollege(CUNY)forthe2019‐2020award
year.
Student’sSignature:_____________________________________Date:_________________________
F. ChildSupportReceived&Paid
ChildSupportReceived DidnotreceiveanyChildSupport
NameofAdultWho
ReceivedtheSupport
NameofChildForWhom
SupportWasReceived
AmountofChild
SupportReceivedin2017
ChildSupportPaid DidnotpayanyChildSupport
NameofPersonWho
PaidChildSupport
NameofPersontoWhom
ChildSupportwasPaid
NameofChildforWhom
SupportwasPaid
AmountofChild
SupportPaidin2017


G. Certification
Ifyouaretheparentorthestudent,bysigningthisapplication,youcertifythatalloftheinformationyouprovidedistrueandcompletetothebest
ofyourknowledgeandyouagree,ifasked,toprovideinformationthatwillverifytheaccuracyofyourcompletedform.

Student’sSignature Date Parent’sSignature Date
Download
Save PDF to desktop
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Email completed PDF
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Form 20192020: V1 TheU.S.Dept.ofEducationselectedyourapplicationforreviewinaprocesscalledVerification.Inthisprocess,weare (CUNY Kingsborough Community College)

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Completed 21 September 2020

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