List the amount of other untaxed income not reported and not excluded elsewhere on this form. Include untaxed income such as workers’
compensation, disability, Black Lung Benefits, untaxed portions of health savings accounts from IRS Form 1040 Line 25, Railroad Retirement
Benefits, etc.
Do not include any items reported or excluded in B – E above. In addition, do not include student aid, Earned Income Credit, Additional Child Tax
Credit, Temporary Assistance to Needy Families (TANF), untaxed Social Security benefits, Supplemental Security Income (SSI), Workforce
Investment Act (WIA) educational benefits, combat pay, benefits from flexible spending arrangements (e.g., cafeteria plans), foreign income
exclusion, or credit for federal tax on special fuels.
Type of other untaxed income
Total amount received between
January 1 - December 31, 2014
G. Money received or paid on the student’s behalf
List any money received or paid on the student’s behalf (e.g., payment of student’s bills) and not reported elsewhere on this form. If someone is
paying rent, utility bills, etc., for the student or gives cash, gift cards, etc., include the amount of that person's contributions unless the person is
the student’s parent whose information is reported on the student’s 2015–2016 FAFSA. Amounts paid on the student’s behalf also include any
distributions to the student from a 529 plan owned by someone other than the student or the student’s parents, such as grandparents, aunts and
uncles of the student, etc.
Purpose
(e.g. Cash, Rent, Books, Cell Phone, Auto Insurance…)
Total amount received between
January 1 - December 31, 2014
H. Additional information
So that we can fully understand the student’s family's financial situation, please provide below information about any other resources, benefits,
and other amounts received by the student and any members of the student’s household. This may include items that were not required to be
reported on the FAFSA or other forms submitted to the financial aid office, and include such things as federal veterans education benefits, military
housing, SNAP, TANF, etc.
Type of financial support
Total amount received between
January 1 - December 31, 2014
I. Certifications and Signatures
The student must sign and date below. If married, the spouse’s signature is optional. Each person signing below certifies that all of the information
reported is complete and correct. WARNING: If you purposely give false or misleading information you may be fined, be sentenced to jail, or
both.
CLU Office of Financial Aid
60 West Olsen Road #1375
Thousand Oaks, CA 91360
EMAIL: finaid@callutheran.edu
FAX: (805) 493-3114
Student’s Signature - Required
