Sonoma State University-McN-Independent Income Verification

Applicant Name:*

First NameLast Name

Email*

example@example.com

I,(Applicant Name), am financially responsible for myself and am not listed as a dependent on a parent/guardian tax return.

Please complete Box A (if you filed 2024 taxes) or Box B (if you did not file 2024 taxes)

Box A If you filed a 1040 for 2024:Enter amount from Line 15 (Taxable Income)

Enter total number of dependents listed (including self) on tax form:

Box B If you did not file a 1040 for 2024:Enter your estimated income

I supported ______ persons (including self and dependents) in the household during this period.

Under penalties of perjury, I declare that I have examined this form, and to the best of my knowledge and belief, the information is true, correct, and complete.

Applicant Signature

Date

Definitions

Independent Student:

You are considered independent if you are:
1) 24 years of age by December 31 of the award year;
2) Married and/or have legal dependents other than spouse;
3) A Veteran/Member of the U.S. Armed Forces;
4) An orphan, in foster care, or a ward of the court;
5) Before age 18, an emancipated minor or in legal guardianship as determined by a court;
6) As an unaccompanied youth, homeless, or at risk of becoming homeless, or;
7) Is a student whom the financial aid administrator has determined to be financially independent.

Taxable Income:

Taxable income is the amount on a tax return, less any allowable deductions. This is the amount of your income that is subject to income tax. This amount can be found on Line 15 of your 1040 Federal Tax Return.

Dependents/Household Size:

The number of individuals who are reported as dependents on a tax return.

Why do we ask for this information?:
As a federally funded program, we are bound by federal regulations that require all McNair Scholars Programs to provide documentation that each student meets the eligibility requirements. Eligible students for the McNair Scholars Program are first-generation college students who are low-income and/or students who are members of groups historically underrepresented in graduate education (African American/Black, Hispanic/Latino, American Indian/Alaskan Native, or Native Hawaiian/Pacific Islander). At least two-thirds of the participants must meet federal low-income guidelines.

Privacy Policy:
The Sonoma State University McNair Scholars Program is dedicated to protecting our participants’ personal information.

Any information collected here will be stored securely and will never be shared with any individual or agency aside from the U.S. Department of Education for reporting purposes.

Questions?
If you need help with this form, or have any questions, do not hesitate to contact us at mcnairscholars@sonoma.edu.

If you would like to contact our Program Director, Dr. Daniel Malpica, please email daniel.malpica@sonoma.edu or call 707-664-2264