Fillable 2020 Pfyi With Date

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2020 Pfyi With Date

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The 2020 Pfyi With Date form is 2 pages long and contains:

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Country of origin: US
File type: PDF

U.S.A. forms for University of California, Santa Cruz

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UCSC Student’s ID /Account
Number (Do not use CRUZ ID)
UCSC Student’s Last Name
First Name
FINANCIAL AID AND SCHOLARSHIP OFFICE
uc santa cruz
PLEASE COMPLETE BOTH PAGES OF THIS FORM
Page 1 of 2
2019-20 Parent Future Year Income Estimate and Expenses
Please provide an estimate of your expected income using the dates provided. Please do not leave blanks. If the answer is zero, or does
not apply to you, enter
“0”.
Please be advised that due to FERPA (Family Education Rights and Privacy Act) laws, our oce will only speak with third parties
(including parents) if authorized on the “Authorization to Release Information” form provided directly to UCSC students.
Name of parent
(please print) _______________________________________________ Date parent employment changed ______/______/_________
PARENT INCOME STATEMENT
Check this box if you do not le a return
Projected income earned before taxes by Parent 1 $__________________________/for 12 month period listed above
Projected income earned before taxes by Parent 2 $__________________________/for 12 month period listed above
In 2017 or 2018, did you or anyone in your household receive benefits from any of the Federal programs listed below? Mark all programs that apply:
q Supplemental Security Income q Supplemental Nutrition Assistance Program (SNAP) q Free or reduced price lunch q TANF q WIC
Interest & dividend income $_______________
Alimony $ _______________
Business income $_______________
Capital gains (or loss) $_______________
Other gains (or loss) $_______________
Retirement/pension benets $_______________
Rental property, royalties, partnerships,
S corporation, trust income $_______________
Farm income $_______________
Unemployment compensation $_______________
Taxed Social Security benets $_______________
Paid lump sum benets: retirement,
vacation, sick pay, etc. $_______________
Student grant and scholarship aid
to be reported to the IRS in your
adjusted gross income $ _________________
Combat pay $ _________________
Cooperative Education Program
earnings $ _________________
Payments to tax-deferred pension and savings
plan (e.g. 401K) $_______________
IRA, Keogh, SEP, SIMPLE retirement contributions $_______________
Child support Received Paid
Paid by (parent name) _____________________________
For __________________________________________ $_______________
Tax exempt interest $_______________
Untaxed IRAs/pension distributions
excluding rollovers $_______________
Housing, food and other living allowances paid to members of the military,
clergy and others (including cash payments and cash value of benets).
Do not include the value of on-base military housing or the value of a
basic military allowance for housing.
Veterans noneducation benets
Other untaxed income such as workers’ compensation, disability benets, etc.
Also include the untaxed portions of health savings accounts from IRS Form 1040—
line 25. Don’t include extended foster care benets, student aid, earned income
credit, addtional child tax credit, welfare payments, untaxed Social Security Benets,
Supplemental Security Income, Workforce Innovation and Opportunity Act educa-
tional benets, on-base military housing or a military housing allowance, combat pay,
benets from special spending arrangements (e.g. cafeteria plans), foreign income
exclusion, or credit for federal tax on special fuels.
UNTAXED INCOME ANNUAL
TAXABLE INCOME ANNUAL
F0PFYI
Was this included in wage gures above? yes no
$_______________
$_______________
$_______________
name of child/ren
Parent(s) estimated income for the twelve (12) month period of January 1, 2019 through December 31, 2019. Please attach the following as applicable: a
copy of the letter you received which verifies your change
in employment status, a copy of your unemployment claim letter, and all severance package
documentation. You must also submit a complete copy of your 2017 tax transcript and Verification of Untaxed Income, if you have not already
done so.
Click to Print
UCSC Student’s ID /Account
Number (Do not use CRUZ ID)
UCSC Student’s Last Name
First Name
F0
PFYI
Page 2 of 2
Rent or mortgage payment $______________
Property tax $______________
Utilities (gas, electric, phone) $______________
Food and household items $______________
Car and/or transportation (car payments, insurance,
gas, repairs and maintenance, bus) $______________
Medical and dental (not covered by insurance) $______________
Health insurance premiums $______________
Child care and/or elder care $______________
Consumer debts and/or other personal loans $______________
ANNUAL
ANNUAL
Child support paid
(Do not include support paid for
children
living in your home, or for the UCSC student.)
Paid by (parent name) ____________________________
For _________________________________________ $ ______________
Private school tuition paid (attach documentation) $ ______________
Vacation and recreation $ ______________
Other (specify): ___________________________
__________________________________________ $ ______________
(Do not include federal or state taxes as these are
already taken into account)
TOTAL EXPENSES $ ______________
PARENT EXPENSE STATEMENT
If expenses exceed income, explain how you met your expenses below.
name of child/ren
RETURN TO: UC Santa Cruz Financial Aid and Scholarship Oce, 205 Hahn Student Services Building, 1156 High Street, Santa Cruz, CA 95064
Phone: (831) 459-2963 Web: nancialaid.ucsc.edu. For your protection and security, please do not e-mail forms.
PARENT CERTIFICATION
• Iherebydeclarethatallinformationreportedonthisdocumentistrue,complete,andaccuratetothebestofmyknowledge.
• I
understandthatanyfalsestatementormisrepresentationwillbecausefordenial,reduction,cancellationand/orrepaymentoffinancialaid.
Please report your marital status as of the date you submitted the 2019-2020 financial aid application.
As of the date I filed the 2019–20 financial aid application, I, the parent, am (check one box below):
Parent Signature _________________________________________ Date ___/____/_____
Parent Daytime Phone ( _______ ) ____________________________ Parent E-mail Address _____________________________________________
Parent Name ______________________________________________________ Date ____/_____/______
PLEASE PRINT
(Mo/Day/Year)
Never Married
Divorced or Separated
Married/Remarried
Widowed
Unmarried and both parents living together
Month Year
Month and year you were either divorced, separated,
married/remarried, or widowed.
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2020 Pfyi With Date

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Completed 28 April 2020

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