WIDIND
Widowed Student Disclosure
2018-2019
Office of Financial Aid ▪ 100 East 8
th
Street ▪ PO Box 9000 ▪ Holland, MI 49422-9000
P: 616-395-7765 ▪ F: 616-395-7160 ▪ finaid@hope.edu ▪ hope.edu/financialaid
It is our understanding you were widowed after filing the 2018-19 FAFSA. To determine your 2018-19
eligibility for financial assistance, we need further clarification regarding your financial information.
Complete the following items using only your information, excluding
any of your spouse’s
information (even if a joint tax return was filed).
Date you were widowed: ____/____/____
A. Submit a signed copy of your 2016 and 2017 Federal Income Tax Return with W-2 forms.
B. Complete the following information
1.
HOUSEHOLD INFORMATION:
a. Current number in household (excluding your deceased spouse): ________
b. Current number of your household members attending college in 2018-19 ________
2.
UNTAXED INCOME & BENEFITS received during 2017 *
a. Welfare benefits (including TANF). Don’t include food stamps or subsidized housing $_______
b. Social Security benefits received for all household members $_______
c. SSI disability benefits $_______
d. Child support you will receive during the upcoming year for all children
Do not include foster care or adoption payments. $_______
e. Survivor benefits (e.g. life insurance, pensions, VA benefits, etc.) $_______
f. Worker’s compensation $_______
g. Any other untaxed income or benefits. List source(s): _____________ $_______
*
DO NOT INCLUDE THE FOLLOWING UNTAXED INCOME TYPES:
Workforce Investment Act Educational benefits, benefits from flexible spending arrangements
(e.g. cafeteria plans), or combat pay if you are not a tax filer.
3. ASSET INFORMATION: What is it worth today?
What is owed on it?
a. Cash, savings, & checking accounts: $__________
b. Investments (excluding retirement plans): $__________ $_______
c. Other real estate (excluding home): $__________ $_______
d. Business: Name _____________________ $__________ $_______
Is the business more than 50% family-owned and controlled?
YES
NO
Does the business have 100 or fewer full-time equivalent employees?
YES
NO
e. Investment farm: $__________ $_______
Do you “materially participate in the farm's operation”?
YES
NO
Student Signature:
_
_ ________________________________
Date Signed:
