401 S
tudent Additional Financial Information
Student Name: ______________________________ Student ID: _______________________
Please confirm the amounts from 2017 of the following items for the Student:
a. Ed
ucation credits (American Opportunity Tax Credit and Lifetime Learning Tax Credit) from IRS
Form 1040 – line 50 or 1040A – Line 33.
$__
______________
b. Child support paid because of divorce or separation or as a result of a legal requirement. Don’t
include support for children in your household.
$__
______________
c. Taxable earnings from need-based employment programs, such as Federal Work-Study and
need-based employment portions of fellowships and assistantships
$__
______________
d. Taxable college grant and scholarship aid reported to the IRS as income. Includes AmeriCorps
benefits (awards, living allowances and interest accrual payments), as well as grant and
scholarship portions of fellowships and assistantships.
$__
______________
e. Combat pay or special combat pay. Only enter the amount that was taxable and included in your
adjusted gross income. Don’t include untaxed combat pay
$__
______________
f. Earnings from work under a cooperative education program offered by a college
$__
______________
By s
igning below, I certify that all of the information provided above is true and accurate to the best of
my knowledge. I acknowledge that if I purposefully falsify information on any financial aid document, I
may be subject to a fine, prison, or both.
Signature: ________________________________ Date: ___________________
