2019-2020 Additional Financial Information and
Untaxed Income Worksheet (Dependent Student)
Student ID
E
DEPUTX
Legal Name
Indicate the amount from 2017 in the spaces provided. If there is no amount to record,
please use zero or Not Applicable (N/A).
Student Information
Parent Information
$ ________________
Taxable earnings from need-based employment programs, such as
Federal Work-Study and Need-based employment portions of
fellowships and assistantships.
$ ________________
$ ________________
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 cooperative education program offered by
a college.
$ ________________
$ ________________
Child support received for all children in the household. Don’t include
foster or adoption payment.
$ ________________
$ ________________
Housing, food and other living allowances paid to members of the
military, clergy and others (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 noneducation benefits, such as Disability, Death Pension, or
Dependency & Indemnity Compensation (DIC) and/or VA Educational
Work-Study allowances.
$ ________________
$ ________________
Other untaxed income not reported in questions above, such as
workers’ compensation, disability, etc. Also include the untaxed
portions of health savings accounts from IRS Form 1040—line 25.
Don’t include extended foster care benefits, student aid, earned
income credit, additional child tax credit, welfare payments, untaxed
Social Security benefits, Supplemental Security Income, Workforce
Investment Act educational benefits, onbase military housing or a
military housing allowance, combat pay, benefits from flexible
spending arrangements (e.g., cafeteria plans), foreign income
exclusion or credit for federal tax on special fuels.
$ ________________
$ ________________
Money received, or paid on your behalf (e.g., bills), not reported
elsewhere on this form. This includes money that you received from a
parent whose financial information is not reported on this form and
that is not part of a legal child support agreement. Also includes
distributions to you (the student beneficiary) from a 529 plan that is
owned by someone other than you or your parents (such as your
grandparents, aunts, and uncles).
XXXXXXXX
Each person signing this form certifies that all the information reported is complete and correct.
Th
e student and at least one parent must sign and date.
Student Signature
Date
Par
ent Signature
Date
Serv
ice EMU Locations: 240 McKenny Hall & 268 Student Center
.
Fax:
734.487.4281
Email:
financial_aid@emich.edu
.
Web:
www.emich.edu/finaid
