2020 – 2021 NEED BASED FINANCIAL AID APPLICATION

2020 ? 2021 NEED BASED FINANCIAL AID APPLICATION

DEADLINE FOR ALL FORMS IS MARCH 13, 2020

OR FOUR WEEKS FROM ACCEPTANCE FOR ENTERING STUDENTS

FORMS REQUIRED FROM STUDENTS APPLYING FOR NEED BASED GRANT/LOAN FUNDING:

1) FAFSA ON THE WEB ? FREE APPLICATION FOR FEDERAL STUDENT AID

The Federal school code for UCSD Health Sciences is 001317. You may access the FAFSA application online at . Students will be able to login with their FSA ID, which consists of a usercreated username and password. This allows users to electronically access personal information on Federal Student Aid Web sites and electronically sign a FAFSA.

To be considered for school-based grant and loan funding you must complete both the parent and student section of the FAFSA. Exceptions to this are: o You are married at the time you complete the FAFSA and/or; o have children you support or; o you are a Pharmacy student and will be 30+ years old by September 1, 2020.

Several days after electronically filing your FAFSA, you should receive an electronic Student Aid Report (SAR) confirming the information you provided on the application. If you need to correct any of the information, you may do so online at .

2) UCSD HEALTH SCIENCES SUPPLEMENTARY FINANCIAL AID FORM

Students who would like to be considered for school-based grants and loans must complete this form (including parent, spouse and/or domestic partner signatures).

Note regarding State Law AB205: the financial aid eligibility of students who are in a state registered domestic partnership or whose custodial parent (parent providing the FAFSA information) is in a state registered domestic partnership may be impacted by this law. If you think this information applies to you, please review the Domestic Partnership AB 205 Q&A here: .

3) PARENTS' TAX CERTIFICATION FORM & COMPLETED 2018 FEDERAL INCOME TAX RETURN

If your parent(s) DID FILE a 2018 Federal Income Tax Return, the FILING portion of the Tax Certification Form must be completed. Please also submit their 2018 Federal Tax Forms including all applicable Schedules, Forms and W-2s. DO NOT submit copies of State tax returns.

If your parent(s) DID NOT FILE a 2018 Federal Income Tax Return, the NON-FILING portion of the Tax Certification Form must be completed.

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4) STUDENT AND SPOUSE/DOMESTIC PARTNER TAX CERTIFICATION FORM & COMPLETED 2018 FEDERAL

INCOME TAX RETURN If you and your spouse/domestic partner DID FILE a 2018 Federal Income Tax Return, the FILING portion of the Tax Certification Form must be completed. Please also submit your 2018 Federal Tax Forms including all applicable Schedules, Forms and W-2s. DO NOT submit copies of State tax returns. If you and your spouse/domestic partner DID NOT FILE a 2018 Federal Income Tax Return, the NON-FILING portion of the Tax Certification Form must be completed.

5) SPECIAL FUNDING FORM

Students who have received an outside agency scholarship award for the 2020-21 year, or who have applied for/received a service obligation scholarship, may list awards here. Please also respond to the questions regarding required data/biographical information used for annual reporting.

6) RESTRICTIVE SCHOLARSHIP ELIGIBILITY FORM (Medical students only)

Please review this form and select any eligibility criteria which corresponds to your background and/or anticipated practice plans.

7) FEDERAL DIRECT UNSUBSIDIZED AND GRAD PLUS LOAN REQUEST FORM

Students who have a remaining need after the receipt of the school-based grant and loan awards may apply for the Federal Unsubsidized and Grad PLUS Loan(s). When borrowing Direct Unsubsidized and Grad PLUS Loan(s), the student must either pay the interest while enrolled in school or have it accrue and capitalized prior to repayment. Graduate/Professional students are only eligible for Unsubsidized Direct Loans and Graduate PLUS Loans.

Students who have never received a Direct Loan from UCSD School of Medicine or School of Pharmacy will need to complete and electronically sign a new Master Promissory Note (MPN) at the Federal Student Aid website at: . When selecting the school from the dropdown school list, please select Univ. of Calif. San Diego, Health Sciences. A separate Direct Grad PLUS MPN must be signed by students applying for the Direct Grad PLUS Loan.

8) EXPLANATION OF SPECIAL CIRCUMSTANCES FORM (if applicable)

An Expected Family Contribution (EFC) is calculated using the 2018 Adjusted Gross Income (AGI) reported on the FAFSA form. The EFC is then subtracted from your standard student budget in order to determine your eligibility for financial aid. Your EFC can be found on the Student Aid Report (SAR) following completion of the FAFSA form. If you feel that using your 2018 AGI leads to an unrealistic EFC, please complete this form.

*** All forms must be submitted with a hand-written signature***

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HOW TO SUBMIT YOUR APPLICATION:

EMAIL (Preferred): somfinaid@health.ucsd.edu

*Please encrypt or password protect any self-identifying documents sent via email

FAX: (858) 534-1513

MAIL: UCSD HSFAO 9500 Gilman Drive, Mail Code 0606 La Jolla, CA 92093-0606

IN PERSON: UCSD Health Sciences Financial Aid Office Medical Education and Telemedicine Building (MET) Second Floor, Room 240

WE ARE HERE TO HELP If you have questions regarding the application forms or deadlines, please contact our office at (858) 534-4664 or by email at somfinaid@health.ucsd.edu.

OTHER UCSD HEALTH SCIENCES FINANCIAL AID INFORMATION OUTSIDE AGENCY SCHOLARSHIP LISTING Please visit the following link for a listing of outside agency scholarships available for the 2020-2021 year: UCSD School of Medicine ? Outside Agency Scholarship and Loan Listing Skaggs School of Pharmacy ? Outside Agency Scholarship and Loan Listing

CHANGES IN STUDENT'S AND/OR PARENTS' FINANCIAL SITUATIONS In order to ensure that limited school aid funds are being directed to the neediest student situations, we must adjust financial aid packages for those students who submit updated information indicating a change in the student's overall need and eligibility. This means that if you submit estimated parents'/spouse's income information on the FAFSA in order to have it processed by the deadline and later re-submit a FAFSA or any UCSD forms with updated/adjusted parents'/spouse's information with a substantially different income figure, your financial need will be re-evaluated and your financial aid awards may be adjusted.

Please note: You do not need to submit pages 1-3 of this application. 3 of 3

2020-2021 UCSD HEALTH SCIENCES SUPPLEMENTARY FINANCIAL AID FORM ? Page 1 of 3

COMPLETE AND RETURN BY MARCH 13, 2020

_______________________________________________________________________________________________________________

Name (Please print)

Medical Student Pharmacy Student

Year of Graduation

A. STUDENT AND PARENT INFORMATION:

1) Current Address: _________________________________________________________________________________________

Street

City

State

Zip

2) E-mail Address: _____________________________________________________________

3) Primary Phone Number: ____________________________ Alternate Phone Number: ______________________________

4) During the 2020-2021 academic year I plan to live: On-Campus Off-Campus With Parents/Family

5) Marital Status: Single

Married

Separated/Divorced (Date of Legal Separation/Divorce: __________)

6) Number of dependent children: _____ Age(s): ____________ How many of your dependent children reside with you? _______

7) Are you (the student) in a registered domestic partnership? Yes No

8) Is your custodial parent (parent completing the FAFSA), in a registered domestic partnership? Yes No

(Please see the AB205 Q&A for definition of a domestic partner located at .)

9) Parent(s) Marital Status: Married & Together Divorced

Separated

Parent(s) Never Married

Parent Widowed

Date of Divorce/Separation ____________ Date Widowed: ____________

10) WAIVER OF MANDATORY HEALTH INSURANCE

Please indicate if you will be applying for a waiver of your mandatory health insurance fees for any of the following quarters:

FALL QTR. 2020

WINTER QTR. 2021

SPRING QTR. 2021

(Waiver of Mandatory Health Insurance must be applied for through the Student Health Insurance Office. The deadline for submitting your waiver is listed on the UCSD Registrar's website at )

B. PARENTS' HOUSEHOLD ? This section is only required of student's that are not married as of the date they completed their FAFSA, do not have children you support and/or Pharmacy students under the age of 30 prior to 9/1/2020. Please provide information on your parent(s) household (the individuals listed here should agree with information you provided on the FAFSA). If your custodial parent (parent completing the FAFSA) is in a registered domestic partnership, please provide information on your parent's domestic partner.

Family Member Age

Relationship To You?

Claimed by Parents

in 2018?

Living with Parents

in 2020-21?

School Attending Employer's Name

or Occupation or Type of College

in 2020-21

(i.e. Comm, State, Priv)

PARENT 1

N/A

PARENT 2

N/A

SELF

N/A

Yes No

OTHER FAM.

Yes No

OTHER FAM.

Yes No

OTHER FAM.

Yes No

(If necessary, list additional family members on a separate sheet.)

N/A N/A

Yes Yes Yes

No No No

Yes No

UCSD

STATE

UCSD HEALTH SCIENCES SUPPLEMENTARY FINANCIAL AID FORM ? Page 2 of 3

C. ADDITIONAL FINANCIAL INFORMATION - PLEASE COMPLETE ALL BOXES. IF THE ANSWER IS ZERO PLEASE PUT ZERO.

11) If your parent(s) do not own a home, what is their monthly rent payment? $____________

12) Do your parents currently reside in San Diego, CA? Yes No

13) If you and/or your parent(s) own a home, please complete the following information: STUDENT (If applicable, include spouse/ domestic partner)

Year home purchased

Purchase Price Present Value

Amount Owed Monthly mortgage

payment

PARENT(S)

14) Please provide asset information for you AND your parent(s) below:

Current cash, savings, checking

*Do not include Financial Aid

proceeds

STUDENT (If applicable, include spouse/ domestic partner)

PARENT(S)

STUDENT (If applicable, include spouse/ domestic partner)

PARENT(S)

What is it worth now?

What is owed on it? What is it worth now? What is owed on it?

Other real estate

Investments

*Do not include retirement account funds

Business

Farm 15) If your parents own a farm, are they living on it? Yes No

UCSD HEALTH SCIENCES SUPPLEMENTARY FINANCIAL AID FORM ? Page 3 of 3

E. CERTIFICATION & AFFIDAVIT - All applicants must read and sign the following statement:

a) I certify that all the information provided by me or any other person on this form is true and complete to the best of my (our) knowledge. If requested by the Financial Aid Office, I agree to give proof of the information that I (we) have given on this form. I (we) also realize that if I (we) do not give proof when asked, I may be denied aid.

b) I agree to report to the Financial Aid Office any change in my marital, domestic partnership or California residency status and any additional earnings, funds or support I may receive. (Any additional earnings, funds or support received from any source may result in the reduction of awards and/or require repayment of financial aid already advanced.)

c) I agree that if I withdraw or cease to carry the required number of units, I will report to the Financial Aid Office to arrange for the repayment of aid advanced to me for which I am no longer eligible.

d) I agree to accept the responsibility for repayment of any loans awarded to me and to attend an exit interview prior to graduation or withdrawal so that the terms of loan repayment can be arranged. (University records may be withheld for failure to attend an exit interview.)

e) I understand that I must enroll at the UCSD School of Medicine or Skaggs School of Pharmacy and Pharmaceutical Sciences and make satisfactory progress in my course of study during each quarter I receive aid.

f) I am not in default on any loan made, insured or guaranteed under a student assistance program for attendance at this campus or any other campus.

I declare that I will use any funds received including those from the College Work-Study, or Federal Direct Loan Programs solely for expenses related to attendance or continued attendance at this campus of the University of California. I further understand that I am responsible for repayment of a prorated amount of any portion of payments made which cannot reasonably be attributed to meeting educational expenses related to attendance at this campus of the University of California. The amount of such repayment is to be determined on the basis of criteria set forth by the U.S. Department of Education.

I affirm that, to the best of my knowledge, I do not owe a repayment on a Pell Grant or Supplemental Educational Opportunity Grant previously received for study at this campus of the University of California. To the best of my knowledge, I am not in default on a Perkins Loan or any Federal Direct and/or Stafford Loan guaranteed or insured by the Department of Education or by a guarantee agency for attendance at this campus of the University of California.

I am also aware that in order to continue to receive assistance from any of the programs mentioned in the preceding paragraph, I must maintain satisfactory progress in the course of study I am pursuing according to the standards and practices of this campus of the University and at least half-time enrollment.

I understand that all offers of aid are contingent on meeting the terms, conditions and qualifications of the individual scholarship, grant and/or loan programs.

SIGNATURES - All people providing information on this form must provide a hand-written signature below.

Signature of Student

Date

Signature of Parent 1

Date

Signature of Spouse/Domestic Partner

Date

Signature of Parent 2

Date

2020-21 UCSD HEALTH SCIENCES FINANCIAL AID PARENT(S) INCOME TAX CERTIFICATION FORM COMPLETE AND RETURN BY MARCH 13, 2020

This form is only required of student's that are not married as of the date they completed their FAFSA and/or do not have children they support, or you are a Pharmacy student who will not be 30+ years old by 9/1/2020.

__________________________________ _________________________________________

Student's Name (Please print)

Class Level in 2020-21

Year of Graduation

CERTIFICATION OF FILING STATEMENT

TAX FILERS: If your parent(s) DID file a 2018 Federal Income Tax Return, please have them sign this portion of the form. They must also submit copies of their 2018 Federal Income Tax Returns including all Schedules, Attachments, and W-2 forms.

(California State Statute 2015.5) The attached copy or copies of joint or separate income tax forms are an exact and complete copy or copies of 2018 IRS Form 1040 filed with the U.S. Internal Revenue Service. I/We certify under penalty of perjury that the information provided on the form along with all attachments is true.

________________________________________ Parent 1 Name (please print)

___________________________________________ Parent 2 Name (please print)

_________________________________________

Parent 1 Signature

Date

____________________________________________

Parent 2 Signature

Date

***** OR *****

CERTIFICATION OF NON-FILING

NON-TAX FILERS: If your parent(s) DID NOT file a 2018 Federal Income Tax Return, please have them sign this portion of the form.

(California State Statute 2015.5) I/We did not file a 2018 IRS Federal Income Tax Return. I/We certify under penalty of perjury that the foregoing is true and correct.

________________________________________ Parent 1 Name (please print)

_________________________________________

Parent 1 Signature

Date

___________________________________________ Parent 2 Name (please print)

____________________________________________

Parent 2 Signature

Date

2020-21 UCSD HEALTH SCIENCES FINANCIAL AID STUDENT INCOME TAX CERTIFICATION FORM COMPLETE AND RETURN BY MARCH 13, 2020

This form is only required if you were married at the time you completed the FAFSA and/or, have children you

support or you are a Pharmacy student and will be 30+ years old by September 1, 2020.

__________________________________ _________________________________________

Student's Name (Please print)

Class Level in 2020-21

Year of Graduation

CERTIFICATION OF FILING STATEMENT

TAX FILERS: If you and your spouse/domestic partner DID file a 2018 Federal Income Tax Return, please sign this portion of the form. You must also submit copies of your 2018 Federal Income Tax Returns including all Schedules, Attachments, and W-2 forms.

(California State Statute 2015.5) The attached copy or copies of joint or separate income tax forms are an exact and complete copy or copies of 2018 IRS Form 1040 filed with the U.S. Internal Revenue Service. I/We certify under penalty of perjury that the information provided on the form along with all attachments is true.

________________________________________ Student Name (please print)

_________________________________________

Student Signature

Date

___________________________________________ Spouse/Domestic Partner Name (please print)

____________________________________________

Spouse/Domestic Partner Signature

Date

***** OR *****

CERTIFICATION OF NON-FILING

NON-TAX FILERS: If you and your spouse/domestic partner DID NOT file a 2018 Federal Income Tax Return, please sign this portion of the form.

(California State Statute 2015.5) I/We did not file a 2018 IRS Federal Income Tax Return. I/We certify under penalty of perjury that the foregoing is true and correct.

________________________________________ Student Name (please print)

_________________________________________

Student Signature

Date

___________________________________________ Spouse/Domestic Partner Name (please print)

____________________________________________

Spouse/Domestic Partner Signature

Date

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