FINANCIAL AID & SCHOLARSHIP OFFICE
1000 East Victoria Street
Carson, California 90747
PHONE: (310) 243-3691
CSUDH ID: Today s Date:
Financial Aid Document Submission Cover Sheet
Please complete the information requested below, submit this form along with your documents.
REMINDER: When uploading your documents to the online Dropbox, please exercise caution when using
Free WiFi or Public Computers as these are not secure.
Student Name:
Enter Last Name, First Name, MI
Toro Email Address:
Phone Number:
(Area Code) (i.e. 222-1234)
Note: Please be sure to include your CSUDH student ID number on each page submitted and allow up to 4
business days for your To Do List to be updated.
SUBMISSION INSTRUCTIONS:
On the following page(s), complete all requested information using the fillable document below. Your
document must be complete to be accepted by the Financial Aid & Scholarship Office. Forms that are
incomplete will remain on your To-Do-List in the Student Center.
1. Upon completing this document, scroll to the bottom where you are asked to sign and date. In the signature
area, type or sign your name and in the date space type today’s date.
2. Save your document and be sure to include your name and CSUDH Student ID# within the file name.
3. If you have attachments, please have them ready to upload to the online Dropbox
4. Return to the Financial Aid Forms page > go to the blue Dropbox Folders section > select the icon that
corresponds with your last name > use the “Add Files” or “drag and stuff here” option to upload your
documents. Emailed documents will not be accepted.
5. Once all documents have been submitted, be sure to close your browser.
In furtherance of CSU Dominguez Hill’s mission of accessibility and commitment to excellence through diversity, equity, and
inclusion, CSUDH strives to ensure that its information and communication technology is accessible to everyone. If you need
assistance in completing this form because of a disability, please contact us at (310) 243-3660
FINANCIAL AID & SCHOLARSHIPS OFFICE
1000 East Victoria Street
Carson, California 90747
(310) 243-3691
Student’s Name:
CSUDH ID#:
2023-2024 Independent Verification Form
Your 2023-2024 Free Application for Federal Student Aid (FAFSA) or California Dream Act Application (CADAA) was
selected by the federal/state processor for secondary review in a process called verification. Applications are randomly
selected and you are asked to validate the information provided on your application is accurate. CSUDH will compare your
FAFSA or CADAA data with the information on this form and with any other submitted documents. If there are any
differences, CSUDH may need to correct information on your application.
•
Submit electronically to the Financial Aid Dropbox located at csudh.edu/financial-aid/forms.
•
Emailed documents will not be accepted
A.
INDEPENDENT STUDENT’S FAMILY INFORMATION
List below the people in your household. Include:
Yourself;
Your spouse, if you are married;
Your children, if you will provide more than half of their support from July 1, 2023 – June 30, 2024, even if the
children do not live with you.
Other people if they now live with you AND you provide more than half of the other person’s support, and will
continue to provide more than half of that person’s support through June 30, 2024.
Full Name Age Relationship Will be enrolled at
least half time
(Yes/No)*
College*
Self
Yes
CSU
Dominguez Hills
*Include the name of college for any listed household member and if he/she is, or will be, enrolled at least half
time in a degree, or undergraduate certificate program at an eligible postsecondary educational institution any
time between July 1, 2023 and June 30, 2024. Additional documentation may be requested if we have reason to
believe that the information regarding the household member enrolled in the eligible postsecondary educational
institution is inaccurate.
If more space is needed, attach a separate pag
e with your name and student ID number at the top.
Updated 02242023
FVRI24
Student’s Name: CSUDH ID#:
B.
STUDENT’S INCOME INFORMATION (Check only ONE response)
I have used the IRS Data Retrieval Tool (DRT) in FAFSA on the Web to transfer my (and my spouse’s, if
married) 2021 IRS income tax return information into my FAFSA.
I have filed and am unable to or choose not to use the IRS DRT in FAFSA on the Web and have instead attached a
signed copy of my (and my spouse’s, if married) 2021 U.S. Individual Income Tax Return (Form 1040) with all
schedules.
I (and/or my spouse, if married) was not required by federal law to file a 2021 U.S. Individual Income Tax
Return (Form 1040) with the IRS.
Please s
ubmit one
of t
he
f
ollowing docume
nts and complete the table below.
IRS Verification of Non-Filing Letter (dated on or after October 1, 2022)
Request for FREE online at: http://www.irs.gov– Click on “Get Your Tax Record” then select “Get
Transcript ONLINE” or “Get Transcript by MAIL.” Make sure to request the “Verification of Non-
Filing Letter.”
2023-2024 Non-Filing Letter Exception form- I (and my spouse, if married) have attempted and are unable
to obtain the IRS Verification of Non-Filing Letter from the www.irs.gov website.
Available on the CSUDH Financial Aid & Scholarships Office website at
csudh.edu/financial-aid/forms/.
Listed below are my (and/or spouse, if married) sources of 2021 income earned from work, the amount of
income from each source, and all other sources of financial assistance received in 2021 to meet basic living
expenses. I have attached copies of all 2021 W-2 forms.
Source (Name of Employer, Person, agency, etc.)
Type
(work, benefits, family
assistance, financial aid, etc.)
2021 Amount
Student
2021 Amount
Spouse
If more space is needed, attach a separate page with your name and student ID number at the top.
C.
If you (and/or your spouse, if married) changed or corrected your original 2021 income tax return filed with the
IRS, you must submit the following:
Signed copy of the
2021 Amended U.S. Individual Income Tax Return (1040X) with all schedules attached
that was filed with the IRS.
D.
CERTIFICATION AND SIGNATURE
Each person signing below certifies that all of the information
reported is complete and correct.
WARNING: Per the U.S. Department of
Education and the State of California, if you
purposely give false or misleading information
you may be fined, be sentenced to jail, or both.
Student’s Signature (Required) Date
Spouse’s Signature (Optional) Date
Updated 02242023
FVRI24
