Office of Financial Aid
130 Student Union
3640 Colonel Glenn Hwy.
Dayton, OH 45435-0001
Phone: (937) 775-4000
E-mail: raiderconnect@wright.edu
FAX: (937) 775-4410
This form is used to verify the Untaxed Income reported on the FAFSA (Student question 45 and Parent question 94). In
general, these figures are not greater than the Adjusted Gross Income. Please confirm the amounts of the Untaxed Income
reported on the FAFSA. Independent Students do not need to include parental data.
University ID (UID) - Required
PARENT(S) 2017
AMOUNT
(Dependent
Students ONLY)
STUDENT/
SPOUSE 2017
AMOUNT
Payments to tax-deferred pension and retirement savings. List any payments
(direct or withheld from earnings) to tax-deferred pension and retirement savings
plans (e.g., 401(k) or 403(b) plans), including, but not limited to, amounts reported on
W-2 forms in Boxes 12a through 12d with codes D, E, F, G, H, and S.
IRA deductions and payments to self-employed SEP, SIMPLE Keogh and other
qualified plans. Reported on IRS Form 1040 on lines 28 + 32 or 1040A line 17.
Child Support received. List the actual amount of any child support received in
2017 for the children in your household.
Tax exempt interest income. Reported on IRS Form 1040 line 8b or 1040A line 8b.
Untaxed portions of IRA distributions. Reported on IRS Form 1040 lines (15a
minus 15b) or 1040A lines (11a minus 11b). Exclude rollovers. If amount negative,
enter zero in the box.
Untaxed portions of pensions. Reported on IRS Form 1040 lines (16a minus 16b)
or 1040A lines (12a minus 12b). Exclude rollovers. If amount negative, enter zero in
the box.
Housing, food, and other living allowances paid to members of the military,
clergy, and others. Include cash payments and/or the cash value of benefits
received.
Veteran’s non-education benefits. List the total amount of veterans non-education
benefits received in 2017. Include Disability, Death Pension or Dependency &
Indemnity Comp. (DIC) and/or VA Educational Work Study allowances.
Other untaxed income: worker’s compensation, disability, Railroad Retirement
Benefits, etc. Do not include: welfare, social security, SSI, WIA educational benefits,
financial aid or combat pay.
Money received or paid on the student’s behalf.
List any money received or paid on the student’s behalf in 2017(e.g., payment of
student’s bills) and not reported elsewhere on this form.
By signing this worksheet, I (we) certify that all information entered is complete and correct.
(Electronic signatures are not accepted)
Student Signature (required)
ParentSignature (if dependent student)
2019-2020
Verification of Untaxed
Income Form
VRUTIE - Ver Untaxed Income
