midlandstech.edu/eoc
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PO Box 2408
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Columbia, SC 29202
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803.822.3749
updated 8/30/19
Participant Name
Participant Date of Birth
/ / Participant Social Security Number – –
REQUIRED INFORMATION FOR PARENT/STEP-PARENT 1
Legal First and Last Name
REQUIRED INFORMATION FOR PARENT/STEP-PARENT 2
Legal First and Last Name
Parent/Step-Parent 1 First and Last Name Parent/Step-Parent 2 First and Last Name
Social Security Number – – Social Security Number – –
Social Security Number Social security number
Date of Birth / / Date of Birth /
/
Date of birth Date of birth
Check if parent/step-parent is currently a dislocated worker
Check if parent/step-parents currently a dislocated worker
Have your parent(s) completed a IRS tax return or other tax document? (check one)
Total Wages, Salary, Tips $
Already filed
Will file
Will not file
Have your parent(s) completed a IRS tax return or other tax document? (check one)
Total Wages, Salary, Tips $
Already filed
Will file
Will not file
Have your parent(s) completed a IRS tax return or other tax document? (check one)
Total Wages, Salary, Tips $
Already filed
Will file
Will not file
Have your parent(s) completed a IRS tax return or other tax document? (check one)
Total Wages, Salary, Tips $
Already filed
Will file
Will not file
FAFSA SPECIFIC QUESTIONS FOR PARENTS
As of today, what is your parents’ marital status? (check one)
Never Married
Married/Remarried
Divorced
Separated
Widowed
Month and year your parents were married, separated, divorced, widowed, or remarried? /
Check if anyone in the household received any of the following benefits in
, or
(check years)
:
American Opportunity, Hope or Lifetime Learning tax credits
$
Child support paid
$
Taxable earnings from work-study, assistantships or fellowships
$
Taxable grant and scholarship aid reported to the IRS
$
Combat pay or special combat pay
$
__
Cooperative education program earnings
$
__
Supplemental Security Income (SSI)
Supplemental Nutrition Assistance Program (SNAP)
Free or Reduced Priced School Lunch
Family Independence (FI)
Payments to tax-deferred pension and savings plan
$
Child support received
$
IRA deductions and payments to self-employed
SEP, SIMPLE and Keogh
$
Special Supplemental Nutrition Program for Women, Infants and Children (WIC)
Note: Food stamps and/or TANF may have a different name in your state
PARENT INCOME (COMBINE IF MARRIED)
As of today, what is your parents’ total current balance of cash, savings, and checking accounts? $
As of today, what is the net worth of your parents’ investments, including real estate? Don’t include
the home in which your parents live or retirement funds. Net worth means current value minus debt. $
As of today, what is the net worth of your parents’ current businesses and/or investment farms? Don’t
include a family farm or family business with 100 or fewer full-time or full-time equivalent employees. $
Tax exempt interest income
$
Untaxed portions of IRA distributions
$
Untaxed portions of Pension distributions
$
Housing, food and other living allowances paid to members of the
military, clergy, etc. $
Veterans non-education benefits
$
Other untaxed income not reported, such as workers’ compensation
or disability $
2017
2017
2018
2018
Medicade