Lorain County Community College Financial Services 1005 N. Abbe Rd, Elyria, OH 44035 Phone: 440-366-4034 Page 1 of 2
Additional Financial Information Form
(FAFSA Code 400/401)
2020-21 Financial Aid Year
Section 1. Student Information
Last Name First Name Middle Initial
LCCC Student ID #
This form has 2 pages.
Section 2. Income From Work Calendar Year 2018
Complete the table below. Enter "0" where appropriate. Do not leave blanks. OR, in lieu of completing the table, submit copies of
2018 W-2s and Schedule C (if applicable).
Type of Earnings Student Spouse Parent 1 Parent 2
Earnings from work (wages, salaries, tips, etc.) from W-2s, Schedule C.
(Add 1040 line 1 + Schedule 1, Line 12 + Schedule 1, Line 18 + Schedule K-
1 Form 1065, Box 14, Code A)
Payments to tax-deferred pension and retirement plans including, but
not limited to, amounts reported on W-2 forms in Boxes 12 a through
12 d, codes D, E, F, G, H, and S.
Section 3. Information from 2018 Tax Forms
Complete the table below. Enter "0" where appropriate. Do not leave blanks. OR, in lieu of completing the table, submit copies of
2018 tax return transcripts from the IRS or signed 1040 forms.
Type of Earnings Student Spouse Parent 1 Parent 2
Education credits from IRS Form 1040 Schedule 3, Line 50.
IRA deductions and payments to self-employed SEP, SIMPLE, Keogh, and
other qualified plans from IRS Form 1040 Schedule 1, Line 28 + Line 32.
Tax exempt interest income from IRS Form 1040 Line 2 a.
Untaxed portions of IRA, Pension, and Annuity Distributions
(withdrawals) from IRS Form 1040 Line 4a minus 4b. If any line is
negative, enter zero. Exclude rollovers.
Continue to Section 4 on page 2.
Lorain County Community College Financial Services 1005 N. Abbe Rd, Elyria, OH 44035 Phone: 440-366-4034 Page 2 of 2
Section 4. Other 2018 Financial Information
Complete the table below. Enter "0" where appropriate. Do not leave blanks.
Type of Earnings Student Spouse Parent 1 Parent 2
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 (as reported on the FAFSA).
Taxable earnings from need-based employment programs, such as
Federal Work-Study and need-based employment portions of
fellowships and assistantships.
Taxable college grants and scholarship aid reported to the IRS as
income.
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.
Earnings from work under a co-op program offered by a college.
Child support received for all children. Don't include foster care or
adoption payments.
Housing, food, and other living allowances received because you
are a member of the clergy (and other professions) including cash
payments and cash value of benefits. Don't include the value of on-
base military housing or the value of a basic military allowance for
housing.
Veterans non-education benefits, such as Disability, Death Pension,
or Dependency and Indemnity Compensation (DIC), and/or VA
Educational Work-Study Allowances.
Other non-taxed income not reported elsewhere, such as workers'
compensation, disability, etc. Don't include student aid, earned
income credit, additional child tax credit, untaxed Social
Security/Social Security Income benefits, etc.
Money received, or paid on your behalf (e.g. bills, etc.) not reported
elsewhere on this form.
Section 5. Certification.
Each person signing this worksheet certifies that all of the information reported on it is complete and accurate. Warning: If you
purposely give false or misleading information on this worksheet, you may be fined, sentenced to jail, or both.
Student Signature: Date
Parent Signature
(Dependent Students Only) Date
Electronic signatures will not be accepted. Please print this form to sign before submitting.
Section 6. Submission
Do not submit this form until you have gathered all other required documents/forms to avoid delays in processing. When all required documents have been
gathered, you may submit your information by: a) mail to the address below; b) fax to 440-366-4634 or; c) deliver to Financial Services, First Floor, Bass Library.
Watch for two-sided documents. Be sure to include both sides when faxing. Do not email any documents with personally identifiable information.
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