Fillable 2019 EOP FINANCIAL INFORMATION FORM (State University of New York College of Agriculture and Technology at Cobleskill)

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2019 EOP FINANCIAL INFORMATION FORM (State University of New York College of Agriculture and Technology at Cobleskill)

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BROWSE STATE UNIVERSITY OF NEW YORK COLLEGE OF AGRICULTURE AND TECHNOLOGY AT COBLESKILL FORMS

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Questions? Contact the EOP office at a campus to which you have applied. (See www.suny.edu/attend/apply-to-suny/eop-financial.)
Answer all of the questions below to help determine if you qualify for exclusion from the income eligibility guidelines.
Are you or your family primarily dependent on public assistance payments from Temporary Assistance to
Needy Families (i.e. Family Assistance, Safety Net)? Yes No
Are you in foster care as established by the court? Yes No
Are you a ward of the court or county? Yes No
If you answered “Yes” to either of the last two questions above, skip to Section 8.
All others, continue to Section 3.
Answer all of the questions below to help determine your dependency status.
Were you born before January 1, 1996? Yes No
As of today, are you married? (Also answer “yes” if you are separated, but not divorced.) Yes No
Are you currently serving on active duty in the U.S. Armed Forces for purposes other than training? Yes No
Are you a veteran of the U.S. Armed Forces? Yes No
Do you now have or will you have children who will receive more than half of their support from you
between July 1, 2019 and June 30, 2020? Yes No
Do you have dependents (other than your children or spouse) who live with you and who receive more
than half of their support from you, now and through June 30, 2020? Yes No
At any time since you turned age 13, were both your parents deceased, were you in foster care or
were you a dependent or ward of the court? Yes No
As determined by a court in New York State, are you or were you an emancipated minor? Yes No
Section 2. Exceptions to Income Guidelines
Section 3. Dependency Status
1
The information you provide here will be used in the review of your eligibility for the Educational Opportunity Program. It is to your
advantage to provide as much information as possible. You may type and save your answers on this form. Once it is complete, print
and mail a copy of the completed form with required documents to: Application Services Center, The State University of New York, State
University Plaza, P.O. Box 22007, Albany, NY 12201-2007. Your information will be transmitted to SUNY campuses to which you have
applied for EOP, and that accept this form. (See www.suny.edu/attend/apply-to-suny/eop-financial.)
Section 1. Personal Information
Name: _______________________________________________________
Address: _______________________________________________________
_______________________________________________________
Date of Birth: _______________________________________________________
2019 EOP FINANCIAL INFORMATION FORM
U.S. Citizen: Yes No If no, permanent resident: Yes No
Applicant ID Number:
High School CEEB Code:
Entry Term:
Date:
_____________________
_____________________
_____________________
_____________________
Questions? Contact the EOP office at a campus to which you have applied. (See www.suny.edu/attend/apply-to-suny/eop-financial.)
Section 3. Dependency Status (continued)
Section 4. Parent Information - FOR DEPENDENT STUDENTS ONLY
Does someone other than your parent or stepparent have legal guardianship of you, as determined
by a court in your state of legal residence? Yes No
At any time on or after July 1, 2018, did your high school or school district homeless liaison determine
that you were an unaccompanied youth who was homeless or were self-supporting and at risk of
being homeless? Yes No
At any time on or after July 1, 2018, did the director of an emergency shelter or transitional housing
program funded by the U.S. Department of Housing and Urban Development determine that you were an
u
naccompanied youth who was homeless or were self-supporting and at risk of being homeless? Yes No
At any time on or after July 1, 2018, did the director of a runaway or homeless youth basic center or
transitional living program determine that you were an unaccompanied youth who was homeless or
were self-supporting and at risk of being homeless? Yes No
If you answered “No” to all of the questions above, your status is “Dependent” for the purposes of this form. Continue to Section 4.
If you answered “Yes” to any of the questions above, your status is “Independent” for the purposes of this form. Skip to Section 5.
Dependent students must complete this section. Independent students should leave this section blank. For the purposes of this form,
“legal parent” means your (biological or adoptive) parent, or a person that the state has determined to be your legal parent. Grandparents,
foster parents, stepparents, legal guardians, widowed stepparents, aunts, uncles and siblings are not considered legal parents on this form
unless they have legally adopted you.
What are the names of your legal parents (biological or adoptive)? Legal Parent 1: ________________________________________
Legal Parent 2: ________________________________________
What is the relationship of your legal parents to each other? Married Divorced/Separated
Not married and Widowed
living together
Never married
If your legal parents were married to each other at one time,
provide the month and year they were married, separated,
divorced or widowed to or from each other. __________________________ ______________
If your legal parents are married to each other, or are not married but living together, skip to the last question in this section.
If your legal parents are not married to each other and do not
live together, which parent did you live with more during the
past 12 months? Legal Parent 1 Legal Parent 2 Neither Parent
If you answered “Neither Parent” above, which parent provided
more financial support during the past 12 months? Legal Parent 1 Legal Parent 2 Neither Parent
Is the legal parent identified in either of the last two questions
above currently married or remarried? Yes No
Provide the month and year that the parent identified above
married or remarried. __________________________ ______________
If you did not live with either of your legal parents during the _________________________________ ___________________
past 12 months, with whom did you live? Name Relationship to you
_________________________________ ___________________
Name Relationship to you
Month Year
Month Year
2
Questions? Contact the EOP office at a campus to which you have applied. (See www.suny.edu/attend/apply-to-suny/eop-financial.)
Section 6. Additional Household Income
Report all additional income received in your household for the tax year 2017.
If the answer is 0 or the question does not apply to you, enter 0.
Dividends, interest, or other income from investments: $ ___________________________
Rents paid to you: $ ___________________________
Social Services/Public Assistance (TANF, SNAP, etc): $ ___________________________
Social Security benefits: $ ___________________________
Supplemental Security Income (SSI): $ ___________________________
Workers Compensation/Disability: $ ___________________________
Pension/Annuity: $ ___________________________
Unemployment: $ ___________________________
Veterans Noneducation Benefits: $ ___________________________
Alimony/Maintenance: $ ___________________________
Child Support: $ ___________________________
Other income, including money received or paid on your behalf,
e.g. bills, not reported elsewhere on this form. This includes money
that you received from a parent or other person whose financial
information is not reported above and that is not part of a legal
child support agreement (specify): ___________________________ $ ___________________________
SelfApplicant
Provide the following information for all household members.
D
ependent Students: Include yourself, the parent(s) with whom you live, your stepparent if applicable, their other dependent children
(even if they do not live with you) if your parent(s) will provide more than half of their support between July 1, 2019 and June 30, 2020,
and other people if they now live with you, your parent(s) provide more than half of their support and your parent(s) will continue
to provide more than half of their support between July 1, 2019 and June 30, 2020.
Note to students not living with a parent: Under very limited circumstances (for example, your parents are incarcerated; you have
l
eft home due to an abusive family environment; or you do not know where your parents are and are unable to contact them), you may
be able to submit your SUNY EOP Financial Information Form without parental information. Contact the EOP Office at a campus to
which you intend to apply for further instructions.
Independent Students: Include yourself, your spouse (if married), your children (if any) if you will provide half of their support between
July 1, 2019 and June 30, 2020, even if they do not live with you, and other people if they now live with you, you provide more than half
o
f their support and you will continue to provide more than half of their support between July 1, 2019 and June 30, 2020.
If there are more than 6 members in your household, attach a separate sheet providing the same information for each additional person
in your household.
Name Age Relationship Employed Wages and Filed a Dependent on the
in 2017? tips earned 2017 federal same income that
in 2017 tax return? supports you?
__________________________ ____ _____________ Yes No $ __________ Yes No Yes No
__________________________ ____ _____________ Yes No $ __________ Yes No Yes No
__________________________ ____ _____________ Yes No $ __________ Yes No Yes No
__________________________ ____ _____________ Yes No $ __________ Yes No Yes No
__________________________ ____ _____________ Yes No $ __________ Yes No Yes No
__________________________ ____ _____________ Yes No $ __________ Yes No Yes No
Section 5. Household Information
3
Questions? Contact the EOP office at a campus to which you have applied. (See www.suny.edu/attend/apply-to-suny/eop-financial.)
Section 7. Household Assets
Section 9. Personal Essay
Some of the campuses to which you have applied may require a Personal Essay. (See www.suny.edu/attend/apply-to-suny/eop-financial.)
If so, please provide a response to the following questions (up to 500 words) to help us better understand your interest in EOP.
Attach your response to this form. Be sure to include your name on the attachment.
1. What motivated your interest to pursue post-secondary education?
2. Explain the circumstances that affected your academic performance in high school.
3. Based on what you know about the Educational Opportunity Program, how do you think the program will benefit you?
R
eport the current value of the following assets held by your household. Independent students are not required to report information
regarding assets held by parents. If the answer is 0 or the question does not apply to you, enter 0.
Your cash, checking and savings accounts: $ ______________________
Your investments (non-retirement): $ ______________________
Your trust fund/settlement: $ ______________________
Spouse’s cash, checking and savings accounts: $ ______________________
Spouse’s investments (non-retirement): $ ______________________
S
pouse’s trust fund/settlement: $ ______________________
First parent’s cash, checking and savings accounts: $ ______________________
First parent’s investments (non-retirement): $ ______________________
Second parent’s or Stepparent’s cash, checking and savings accounts: $ ______________________
Second parent’s or Stepparent’s investments (non-retirement): $ ______________________
Purchase Year Purchase Price Current Value Current Debt Monthly Mortgage
Business or farm owned by you,
your spouse or your parent(s): ____________ $ ___________ $ ___________ $ ___________ $ ___________
Home owned by you, your spouse
or your parent(s): ____________ $ ___________ $ ___________ $ ___________ $ ___________
Other real estate owned by you,
your spouse or your parent(s): ____________ $ ___________ $ ___________ $ ___________ $ ___________
Payment
4
Section 8. Other Information
Please indicate if you currently participate in any of following programs:
Educational Opportunity Center (EOC) GEAR-UP Talent Search Upward Bound
Early College, Middle College or Gateway to College STEP Liberty Partnership TRIO
Have you filed for FAFSA? Yes No
Have you applied for TAP? Yes No
Questions? Contact the EOP office at a campus to which you have applied. (See www.suny.edu/attend/apply-to-suny/eop-financial.)
Section 10. Certification
I understand that I must be academically and economically eligible for EOP and that I must provide required documentation with this
form to prove my eligibility. I understand that I am required to file the 2019-20 Free Application for Federal Student Aid (FAFSA) as soon
as possible after October 1, 2018. I understand that additional paperwork may also be required.
All information submitted is true to the best of my knowledge. I understand that any knowing falsification or omission of data may result
i
n the denial of admission or dismissal.
Applicant Signature: ________________________________________________ Date: __________________
First Parent’s Signature: ________________________________________________ Date: __________________
S
econd Parent or Stepparent’s Signature: ________________________________________________ Date: __________________
Mail your completed SUNY EOP Financial Information Form together with required documents to: Application Services Center,
The State University of New York, State University Plaza, P.O. Box 22007, Albany, NY 12201-2007. Your completed form must
include the following:
This SUNY EOP Financial Information Form
Your required financial documentation
Your Personal Essay, if required
Mailing Instructions
5
Questions? Contact the EOP office at a campus to which you have applied. (See www.suny.edu/attend/apply-to-suny/eop-financial.)
Required Financial Documentation
You will need to provide the following documents for the tax year 2017 to verify the information reported.
If you reported: You must attach:
You are a Non-U.S. citizen and a permanent resident • Form I-551 (Alien Registration Card)
You are in foster care • Letter or court document from the government, courts,
private agency responsible for your support
You are a ward of the court or county • Letter or court document from the government, courts,
p
rivate agency responsible for your support
You are an emancipated minor or in legal guardianship • Court order or legal document
You are married • Certificate of Marriage
You are on active duty • Military orders
You are a U.S. Veteran • Form DD214
You have been determined to be homeless • Homeless youth determination from your high school
or school district homeless liaison; or
• Homeless youth determination from the director of an
emergency shelter or transitional housing program funded
by the U.S. Department of Housing and Urban
Development; or
• Homeless youth determination from the director of a
runaway or homeless youth basic center or transitional
living program
Income from wages, tips, dividends, interest, rental, business profits If Tax Return Filed:
• IRS form 1040, 1040A or 1040EZ, including all schedules,
or official transcript of tax returns (visit
https://www.irs.gov/individuals/get-transcript)
If No Tax Return Filed:
• Forms W-2 or 1099; and
• IRS Verification of Non-Filing Letter (visit
https://www.irs.gov/individuals/get-transcript)
Income from disability benefits, a pension, annuity, or • Letter from the appropriate institution stating applicable
unemployment benefits year’s total award (if not already reported on a tax return)
• Disabilities Statement
Child Support, Maintenance or Alimony • Signed affidavit, court order or legal document indicating
amount of child support and/or alimony
Public Assistance • A signed letter from the agency stating applicable year’s
total award and names of recipients
Social Security, Supplemental Security Income or • SSA Form 1099 or letter from the agency stating
Veterans Noneducation Benefits applicable year’s total award for each member of the
household including names of individuals
No income • IRS Verification of Non-Filing Letter (visit
https://www.irs.gov/individuals/get-transcript)
• You may be contacted for additional information
Unusual Circumstances • Notarized letters, statements, death certificates, etc.,
that corroborate claims
6
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2019 EOP FINANCIAL INFORMATION FORM (State University of New York College of Agriculture and Technology at Cobleskill)

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Completed 27 August 2020

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