Mail, fax, email, or deliver the completed worksheet to the financial aid office using the contact information listed below.
EMAILED FORMS MUST BE SENT FROM THE IWU STUDENT EMAIL ACCOUNT
Financial Aid Office, IWU National & Global 1900 West 50
th
Street Marion, IN 46953-9393 indwes.edu
800.621.8667 option 4 765.677.2516 765.677.2030 Fax IWUfinaid@indwes.edu
DEPENDENT STUDENT
( ) -
STUDENT INFORMATION
________________________________________ ____ _______________________________________________
First Name M.I. Last Name
___________________ OR __________________ ______________________________________
FC19DSIW
Student ID Last 4 Digits of SSN Phone Number
STUDENT INCOME FROM WORK (DEPENDENT STUDENT)
You indicated that you will not file a 2017 Federal Income Tax Return. If this is correct, you must confirm that you have not
filed and are not required to file a 2017 Federal Income Tax Return by checking the appropriate box below.
I have not filed and am not required to file a 2017 Federal Income Tax Return. I had no income earned from work in
2017.
I have not filed and am not required to file a 2017 Federal Income Tax Return. I have listed below the names of all
employers and the amount earned from each employer in 2017. I have listed every employer even if the employer
did not issue an IRS W-2 form.
Attach copies of all 2017 IRS W-2 Forms issued to you.
EMPLOYER OR SOURCE OF INCOME
STUDENT AMOUNT EARNED IN 2017
A $0 value is assumed for all fields left blank.
$
$
$
$
$
If more space is needed, provide a separate page with the student name and ID number at the top.
CERTIFICATION AND SIGNATURES
By signing this worksheet, I certify that all the information reported on this worksheet is complete and correct.
WARNING: If you purposely give false or misleading information on this worksheet, you may be fined, be sentenced to
jail, or both.
_____________________________________________________________________________ _________________
Student Signature* Date
_____________________________________________________________________________ _________________
Parent Signature* Date
* Must be an actual “wet” signature. A digital signature or typed font signature is not acceptable. This form may be completed and “wet” signed via a tablet
or smartphone with PDF signing capability using a stylus pen. You may need to download an app to access this feature.
