F19STGS
2019-2020 Student Taxable Grants & Scholarships Worksheet
Student Name: SMC ID#
Please verify the taxable student grant and scholarship aid reported to the IRS as income and included in your and your spouse’s (if
applicable) 2017 Adjusted Gross Income. Enter 0 if this does not apply to you, do not leave blank.
• Please consider your response: This worksheet asks for grant and scholarship aid which was reported as taxable
income on your 2017 federal income tax return. Many grants and scholarships are tax free provided they meet
criteria established by the IRS – do not report such tax free grants and scholarships.
• Do NOT report total 2017 grant and scholarships aid. Report only the amount of grants and scholarships which
were taxable and included in your 2017 Adjusted Gross Income.
• Include taxable AmeriCorps benefits (awards, living allowances and interest accrual payments), as well as grant
and scholarship portions of fellowships and assistantships if they were taxable and included in your Adjusted
Gross Income.
Taxable 2017 student grant and scholarship aid reported to the IRS in your 2017
Adjusted Gross Income. Include AmeriCorps benefits (awards, living allowances
and interest accrual payments), as well as grant and scholarship portions of
fellowships and assistantships. DO NOT INCLUDE NON-TAXABLE GRANT OR
$
CERTIFICATION: I certify that all the information reported on this form is true, complete and correct. I understand that
any false statements could be cause for denial, reduction, withdrawal or repayment of financial aid.
Please print and sign before submitting. We CANNOT
accept digital signatures.
Student Signature Date
Spouse’s Signature Spouse’s Printed Name Date
Office of Student Financial Services
One Winooski Park, Box 4
Colchester, VT 05439
Tel. 802-654-3243
Fax: 802-654-2591
