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.
