2019-2020 Parent Additional Financial Information Form
The U.S. Department of Education selected your student’s 2019-2020 FAFSA for review after comparing 2017 Adjusted Gross Income and
other financial information.
You and your spouse, if you are married, must complete this form. You and your student must print, sign,
and submit the form. Instructions for submission are at the bottom of the form.
Do not leave any section blank. If an item does not apply enter “0” or “N/A” in the associated space.
A. Student Information
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 with 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): REQUIRED
Parent One:
Total 2017
Parent Two:
(if Parent is married)
Parent One Name:
Parent Two Name:
(If parent is 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.
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 one 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 Signature Required Date
______________________________________________________________________ _______________
Parent Signature Required (If due to the current national situation your parent cannot Date
sign the form, complete section below)
My parent is not able to sign because_____________________________________________________________________________________
_________________________________________________________________________________________________ ___________________
Student Initials Required
WAYS TO SUBMIT THIS FORM
(1) Upload this form directly into the Student Information System (SIS) by logging into MY VWCC. Once logged in, go to the Student Center
and select the ‘VWCC 19/20 Dependent # in Coll’ from the ‘To Do List’ list to attach and upload the form. (2) Upload the form at
www.virginiawestern.com
by clicking ‘Contact Us,’ and then clicking the 24/7 Student Support icon. Once you log in you can submit
documents. (3) Fax forms to 540-857-6208
♦
Phone: (855)874-6690 (Revised 04_2020)
VWCC Student ID - REQUIRED
Child Support Received. List actual amount received in 2017 for any children in your household. If additional space is needed attach a separate piece of paper
with required information. Do not include foster care payments, adoption payments, or court-order amounts not actually paid.
Child’s Name:
Child’s Name:
