California State University-Channel-SSS-Income Verification

Income Verification Form 2025-2026
TRIO Student Support Services (TRIO SSS) is federally funded and must provide documentation of a student’s eligibility for the program to the U.S. Department of Education. In addition, TRIO regulations state that two- thirds of the students served must meet federal low-income guidelines.
You must complete this form, regardless of whether you believe you qualify as low-income
- Name
  
  First NameLast Name
- Email
  example@example.com
- CWID
- Verification requirements vary depending on whether you are DEPENDENT or INDEPENDENT, according to federal criteria which is available on the FAFSA website: https://studentaid.gov/apply-for-aid/fafsa/filling-out/dependency
- Information for the tax year(2023):
- Part A: Independent Student
- Total Number of Exemptions(Number of people in the Household)
- Taxable Income See line 15 of IRS form 1040
- Or
- Part B: Parent/Guardian Information
  Dependent Students Only
- Taxable IncomeSee line 15 of IRS form 1040
- Or
- I declare under penalty of perjury that the foregoing is true and correct to the best of my knowledge.
- Print Student Name
  
  First NameLast Name
- Print Parent/Guardian Name (if dependent)
  
  First NameLast Name
- Student Signature
  
  Clear
- Print Parent/Guardian Signature (if dependent)
  
  Clear
- Date
  
  MonthDayYear
  Date
- Date
  
  MonthDayYear
  Date

Income Verification Form 2025-2026