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1718-tuition-paid - 1718 Tuition Paid

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Student Name: _____________________________________________________________________________________
Student ID: _________________________________ OR Social Security Number: X X X – X X – ___ ___ ___ ___
Use this form to report tuition payments for a dependent student’s younger sibling(s) attending an elementary, junior
high, or senior high school and/or tuition paid to an accredited college or university if one or both of a dependent student’s
parents is currently enrolled and attending.
1. Complete the follow chart(s). Indicate the name and the relationship to the student of the family member for whom
tuition was paid and the institution to which tuition was paid. Enter the monthly amount of tuition paid. If tuition was
paid in one lump installment, divide the amount by 12 to determine the monthly amount. Complete the second chart
only if tuition was paid for more than one family member. Complete an additional form, as needed, to represent tuition
paid for more than two family members.
Family Member 1
Month
July August September October November December
2017 2017 2017 2017 2017 2017
Amount
Paid
Month
January February March April May June
2018 2018 2018 2018 2018 2018
Amount
Paid
Family Member 2 (if applicable)
Month
July August September October November December
2017 2017 2017 2017 2017 2017
Amount
Paid
Month
January February March April May June
2018 2018 2018 2018 2018 2018
Amount
Paid
CONTINUED ON NEXT PAGE This form is not valid until you have signed and dated the next page
Financial Aid Office, IWU-National & Global 1900 West 50
th
Street Marion, IN 46953-9393 indwes.edu
800.621.8667 option 4 765.677.2516 765.677.2030 Fax IWUfinaid@indwes.edu
201
7
-
201
8
TUITION PAID
NATIONAL & GLOBAL
FINANCIAL AID OFFICE
Name of the family member for whom tuition was paid: _________________________________________________
Relationship to the student: Student’s (
Step
) Sister _____ (
Step
) Brother _____ (
Step
) Mother _____ (
Step
) Father _____
Name of the institution to which tuition was paid: ______________________________________________________
EACH FIELD MUST CONTAIN A NUMERIC VALUE. ENTER $0, IF APPLICABLE.
EACH FIELD MUST CONTAIN A NUMERIC VALUE. ENTER $0, IF APPLICABLE.
Name of the family member for whom tuition was paid: _________________________________________________
Relationship to the student: Student’s (
Step
) Sister _____ (
Step
) Brother _____ (
Step
) Mother _____ (
Step
) Father _____
Name of the institution to which tuition was paid: ______________________________________________________
Student Name: ________________________________________________ Student ID/SSN: ______________________
2. Attach required documentation:
a. Payment contract and/or paid receipts that clearly show the name of the institution to which tuition was paid.
Validation Statement: I certify the information provided is complete and true to the best of my knowledge. Furthermore,
I agree to contact the Financial Aid Office at the time there are changes to the situation on which the request for exception
has been founded. I understand that changes made to my student financial aid eligibility based upon the information
provided affects only the student financial aid received at Indiana Wesleyan University for the 2017-2018 award year.
_________________________________________________________________________ ______________________
Student Signature Date
_________________________________________________________________________ ______________________
Parent Signature (for dependent student only) Date
Mail, email, or fax completed form and supporting documentation to:
Financial Aid Office, IWU-National & Global 1900 West 50
th
Street Marion, IN 46953-9393 indwes.edu
800.621.8667 option 4 765.677.2516 765.677.2030 Fax IWUfinaid@indwes.edu
N
OTE: For each chart, i
f you are
paying a set amount for tuition
on a weekly basis
for the entire duration of July
2017 through June 2018, please keep in mind that there are on average more than 4 weeks per month. To correctly
calculate monthly amounts, you must multiply the weekly amount by 4.3333 (weeks).
2017
-
2018 SPECIAL CIRCUMSTANCES:
TUITION PAID
NATIONAL
& GLOBAL
FINANCIAL AID OFFICE
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Completed 16 November 2019

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