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
July August September October November December
2017 2017 2017 2017 2017 2017
January February March April May June
2018 2018 2018 2018 2018 2018
Family Member 2 (if applicable)
July August September October November December
2017 2017 2017 2017 2017 2017
January February March April May June
2018 2018 2018 2018 2018 2018
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
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: ______________________________________________________