2019–2020 Parent Additional Financial Information Form
Your student’s financial aid application was selected by the U.S. Department of Education for review after 2017 Adjusted
Gross Income and other financial information was compared. You and your spouse, if you are married, must complete this
form. You and your student must sign and submit the form.
Do not leave any section blank. If an item does not apply enter “0” or “N/A” in the associated space. The form must be
submitted to the Financial Aid Office to continue the review process and determine your eligibility for federal student aid.
A. Student Information
__________________________________________________ ________________
Student’s Name (Last, First, M.I.) Student ID - REQUIRED
B. Additional Financial Information
Report total annual amounts for 2017. If an item does not apply use “0” or “N/A.” Boxes left blank will result in additional
information being requested. Additional requests to clarify conflicting information may delay the determination of your
financial aid eligibility. If more space is needed, provide a separate page your name and student ID number at the top.
Additional Financial Information to Verify:
Parent Name(s) for whom the information below is being reported (first and last
name(s)):___________________________________________________________
___________________________________________________________________
Parent(s) Total
2017 Amount:
Parent’s
Spouse’s Total
2017 Amount (if
you are
married):
Education credits (American Opportunity Tax Credit and Lifetime Learning Tax
Credit). List amount from IRS Form 1040 – line 50 or IRS 1040A – line 33.
$
$
Child Support Paid. List amount paid due to a divorce or separation as a result of a
legal requirement. SUPPORT FOR THIS CHILD(REN):
___________________________________________________________________
ADULT RECEIVING PAYMENT: __________________________________________
___________________________________________________________________
$
$
Taxable Earnings from Need-Based employment programs. List amounts from
Federal Work-Study, and assistantships or fellowships, if they are need-based.
$
$
Taxable college grant and scholarship aid, only if it was reported to the IRS in
your Adjusted Gross Income. Amounts include AmeriCorp benefits (awards, living
allowances, and interest accrual payments), as well as grant and scholarship
portions of fellowships and assistantships.
$
$
Combat pay or special combat pay. Only list the amount that was taxable and
included in Adjusted Gross Income. DO NOT INCLUDE UNTAXED COMBAT PAY.
$
$
Earnings from work under a cooperative education program offered by a college. $
$
C. Certification and Signatures
The student and the parent for whom information is provided above MUST sign and date this section. Each person signing
below certifies that all the information reported on this form is complete, correct, and any additional information is attached, if
necessary. WARNING: If you purposely give false or misleading information on this worksheet you may be fined, sentenced
to jail, or both.
______________________________________________________________________ _______________
Student’s Signature Date
______________________________________________________________________ _______________
Parent Signature Date
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