uc santa cruz

FINANCIAL AID AND SCHOLARSHIP OFFICE 

uc santa cruz 

2011–2012 

Independent Student 

Verification Packet 

UCSC Student’s ID /Account 

Number (Do not use CRUZ ID) 

UCSC Student’s Last Name 

First Name 

You have been selected by the UC Santa Cruz Financial Aid and Scholarship Office for a process called “verification” for the 2011-12 

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 95064 

To protect your personal information, do not send completed forms via e-mail. If you have questions about the information 

contained in this packet, please contact us at 831-459-2963. 

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 2010 1040,1040A, 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 STUDENTS 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 4 You must complete all pages of this packet F2IPKT

FINANCIAL AID AND SCHOLARSHIP OFFICE 

uc santa cruz 

2011–2012 

Independent Student 

Verification Packet 




First Name 

1. Print your name and ID/account number clearly at the top of all pages of this packet. 

2. Answer all questions. IF THE ANSWER IS ZERO, OR IS NOT APPLICABLE, WRITE IN A “O”. DO NOT LEAVE BLANKS. 

Federal Tax Return and Income Information 

Student (and spouse) 2010 Income Information 

STUDENT 

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 $____________ 

Do Not Leave Blank 

q Net business income $_______________ 


q Do you own and control more than 50% of a business with over 100 employees q yes 

q no 

SPOUSE 

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 no 

Student (and spouse) other Income Information 

1. Child support received for any of your children. Don’t include foster care or adoption payments. 

List names ______________________________________________________________________ 

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. 

$______________/yr 


$______________/yr 


$______________/yr 


$______________/yr 


5. Money received or paid on your behalf (e.g. bills) not reported elsewhere on this form. $______________/yr 


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. 

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. 

$______________/yr 


$______________/yr 


$______________/yr 


$______________/yr 


10. Earnings from work under a cooperative education program offered by a college. $______________/yr 






First Name 

STUDENT (AND SPOUSE) 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)_____________________________ 

$____________________ 


Do you and/or your spouse 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 2011-12 FAFSA was filed. 

Property 1 (Do not report the home you live in): 

Current Market Value* $ _______________ Mortgage Balance $ _______________ Purchase Price $ _____________ Year Acquired _______ 

Property Address ______________________________________________________________________________________________________ 

Street address City State Zip Code 

Property 2 (Do not report the home you live in): 

Student (and spouse) Real Estate Investments 

Current Market Value* $ _______________ Mortgage Balance $ _______________ Purchase Price $ _____________ Year Acquired _______ 

Property Address ______________________________________________________________________________________________________ 

Street address City State Zip Code 

Complete this section if you 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 

investment net worth on the FAFSA. Complete the following information about the home you live in: 

Current Market Value* $ ___________ Mortgage Balance $ ___________ Purchase Price $ ___________ Year Acquired ______ 

Rental Square Footage ___________ + Home Square Footage ___________ = Total Dwelling Square Footage ___________ 

*on the date you filed the FAFSA 

For Office Use Only 

Total Current Market Value ____________________ Total Mortgage Balance ____________________ INW ________________ 





First Name 

STUDEnt Household Information 

List the people in your household. Include yourself and spouse if married. Include your children (if you provide more than half of their support 

from July 1, 2011 through June 30, 2012). 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, 2012. 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 

2011–2012) 

For those enrolled in 

college for 2011–12, 

list current degree 

objective.* 

UCSC 

Student 

self 

UCSC 

Spouse 

– – 

Other 

Members in 

Household 

– – 

– – 

– – 

– – 

– – 

– – 

– – 

*AA, BA, BS, Certificate, MA, PhD, MD, DDS 

Total number of member(s) listed above who will attend UCSC in 2011–2012: 

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. 

• This document must be received no later than June 1, 2011 to meet the priority deadline for all types of financial aid. 

• I understand that verifications of enrollment will be required if family members are listed in college. 

Please check your marital status as of the date you submitted the 2011-2012 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 

Month 

Month 

Month 

Year 

Year 

Month Year 

Year 

California Registered Domestic Partner 

Month 

Year 

Student Daytime Phone ( _______ ) ___________________________________ Student E-mail 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 95064 

Phone: (831) 459-2963 Web: financialaid.ucsc.edu. For your protection and security, please do not e-mail forms.

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