RAMP Income Verification Form 2020 21

Reading, Advising, & Mentoring Program (RAMP)

TRIO Student Support Services
Cal Poly Pomona

Income Verification Form

2020-2021

The U.S. Department of Education requires income verification for RAMP participants. In lieu of submitting copies of Federal Tax Returns, please complete and submit this form. If you need assistance with completing the form, please email ramp@cpp.edu.

The option to save and resume this application at a later time is available at the bottom of the form.

Name*

First Name

Initial (optional)

Last Name

Bronco ID #*

CPP Email*

STEP ONE: Answer ALL of the following ten questions to determine if you are a dependent or independent student.

1. Were you born before January 1, 1997?*

Yes No

2. As of today, are you married? (Answer "Yes" if you are separated but not divorced)*

Yes No

3. At the beginning of the 2020–21 school year, will you be working on a master’s or doctorate program (such as an M.A., MBA, M.D., J.D., Ph.D., Ed.D., graduate certificate, etc.)?*

Yes No

4. Are you currently serving on active duty in the U.S. Armed Forces for purposes other than traning? (If you are a National Guard or Reserves enlistee, are you on active duty for other than state or training purposes?)*

Yes No

5. Are you a veteran of the U.S. Armed Forces?*

Yes No

6. Do you now have, or will you have, children who will receive more than half of their support from you between July 1, 2020 & June 30, 2021?*

Yes No

7. Do you have dependents (other than your children or spouse) who live with you and who receive more than half of their support from you, now and through June 30, 2021?*

Yes No

8. At any time since you turned age 13, were both your parents deceased, were you in foster care, or were you a dependent or ward of the court?*

Yes No

9. Has it been determined by a court in your state of legal residence that you are an emancipated minor or that someone other than your parent or stepparent have legal guardianship of you? (You also should answer “Yes” if you are now an adult but were in legal guardianship or were an emancipated minor immediately before you reached the age of being an adult in your state. Answer “No” if the court papers say “custody” rather than “guardianship.”)*

Yes No

10. At any time on or after July 1, 2019, were you determined to be unaccompanied youth who was homeless or were self-supporting and at risk of being homeless, as determined by (a) your high school or school district homeless liaison, (b) the director of an emergency shelter or transitional housing program funded by the U.S. Department of Housing and Urban Development, or (c) the director of a runaway or homeless youth basic center or transitional living program?*

Yes No

STEP TWO: Select your dependency status.

Check only one of the following options:*

DEPENDENT: If you answered NO to ALL of the above questions, please provide your parent tax information in STEP THREE. INDEPENDENT: If you answered YES to ANY of the above questions, please provide your tax information in STEP THREE.

STEP THREE: What is your taxable income and household size? (ONLY complete the one section--A or B--that applies to you and include the necessary signature in that section)

SECTION A (DEPENDENT STUDENT): your parent/guardian should complete and sign this section if they filed a Federal Income Tax Return. If no Tax Return was filed, please have your parent/guardian complete Section B.

2019 TAXABLE INCOME (NOT total income or adjusted gross income): (IRS Form 1040—Line 11b)*

NUMBER OF EXEMPTIONS claimed on my 2019 Tax Return was: (add the total # of dependents plus 1 if single; 2 if married)*

Parent/Guardian Signature *

[clear]

Use your mouse or finger to draw your signature above

SECTION A (INDEPENDENT STUDENT): complete this section if you filed a Federal Income Tax Return. If no Tax Return was filed, please complete Section B.

2019 TAXABLE INCOME (NOT total income or adjusted gross income) (IRS Form 1040—Line 11b)*

NUMBER OF EXEMPTIONS claimed on my 2019 Tax Return was: (add the total # of dependents plus 1 if single; 2 if married)*

Student Signature*

[clear]

Use your mouse or finger to draw your signature above

SECTION B (IF NO FEDERAL TAX RETURN WAS FILED): If you (if independent) OR your parent/guardian (if dependent) did NOT file a Federal Income Tax Return, please complete this section.

Indicate which response best reflects the situation:

I receive disability benefits monthly and am not required to file a Federal Income Tax Return. I made less than the amount required to file a Federal Income Tax Return.

Student or Parent/Guardian Signature, as appropriate:

[clear]

Use your mouse or finger to draw your signature above

Date*

The U.S. Department of Education uses the following chart to determine a student’s low-income status:

Family Size 2019 Taxable Income Family Size 2019 Taxable Income
1 $19,140 5 $46,020
2 $25,860 6 $52,740
3 $32,580 7 $59,460
4 $39,300 8* $66,180
*For family units with more than 8 members, add $6,630 for each additional family member.

Save and Resume Later