Dependent Student Additional Information Form

According to your 2014– 2015 Free Application for Federal Student Aid (FAFSA), data was reported for you and/or your parent(s) or spouse on the 2013 Additional Financial Information and Untaxed Income Form. Please submit this form along with your Verification Worksheet(s) and other required documentation to the Office of Student Financial Aid. This form is needed as part of the verification process.

  Student Information





  Additional Financial Information

Please enter 0 if does not apply to you.


Student/Spouse


Parent(s)


Education credits (Hope and Lifetime Learning tax credits) from IRS Form 1040-line 49 or 1040A-line 31.


Child support paid because of divorce or separation or as a legal requirement. Don’t include support for children in your (or your parents’) household, as reported in question 93 (or question 72 for your parents).


Taxable earnings from need-based employment programs, such as Federal Work-Study and need-based Employment portions of fellowships and assistantships.


Taxable student grant and scholarship aid reported to the IRS in your (or your parents’) Adjusted Gross Income. Includes AmeriCorps benefits (awards, living allowances, and interest accrual payments), as well as grant or scholarship portions of fellowships and assistantships.


Combat pay or special combat pay. Only enter the amount that was taxable and included in the Adjusted Gross Income (AGI). Do not enter untaxed combat pay reported on the w-2 (box 12, Code Q).


Earnings from work under a cooperative education program offered by a college.


  Untaxed Income

Payments to tax-deferred pension and savings plans (paid directly or withheld from earnings), including, but not limited to, amounts reported on the W – 2 Form(s) in Boxes 12a through 12d, codes D, E, F, G, H, and/or S.


IRA deductions and payments to self-employed SEP, SIMPLE, and Keogh and other qualified plans from IRS Form 1040 – total of lines 28 + 32 or 1040A-line 17.


Child support received for all children. Don’t include foster care or adoption payments.


Tax exempt interest income from IRS Form 1040-line 8b or 1040A-line 8b.


Untaxed portions of IRA distributions from IRS Form 1040-lines (15a minus 15b) or 1040A-lines (11a minus 11b). Exclude rollovers. If negative, enter a zero here.


Untaxed portions of pensions from IRS Form 1040-lines (16a minus 16b) or 1040A-lines (12a minus 12b). Exclude rollovers. If negative, enter a zero here.


Housing, food, and other living allowances paid to members of the military, clergy, and others (including cash payments and cash value of benefits). Don’t include value of on-base military housing or the value of a basic military allowances for housing.


Veterans’ noneducation benefits such as Disability, Death Pension, or Dependency & Indemnity Compensation (DIC) and/or VA Educational Work-Study allowances.


Other untaxed income or benefits not reported above, such as workers’ compensation, disability, etc. Also, include Homebuyer Tax Credit from IRS Form—line 67. Also, include the First-time Homebuyer Tax Credit from IRS From 1040--line 67. Include any amount reported on the W-2 Form in Box 14.
Don’t include: Student Aid, Earned Income Credit, Additional Child Tax Credit, Welfare Payments, Untaxed Social Security Benefits, Supplemental Security Income, Workforce Investment Act Educational Benefits, On-base Military Housing or a Military Housing Allowance, Combat Pay, Benefits from flexible spending arrangements (e.g., cafeteria plans), Foreign Income Exclusion or Credit for Federal Tax on special fuels.

Money received, or any money paid on your behalf (e.g., bills), not reported elsewhere on this form.


  Signatures




By checking this box, I (we) certify that all the information reported to qualify for Federal Student Aid is complete and correct.


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