IRA/Keogh Follow-Up Form 2019-2020 (Parent)
STUDENT NAME: DATE:
The Office of Financial Aid at Purdue University Northwest will request this documentation only if it is needed to
complete your financial aid file.
DIRECTIONS: Complete this form and return the signed form to the Office of Financial Aid.
The IRS Tax Transcript you provided indicates your parent(s) received an IRA/Keogh distribution in 2017
Further processing of your financial aid will not occur until the information requested below has been
received by the Office of Financial Aid.
According to your parent(s) IRS Tax Transcript, your
parent(s) received an IRA/Keogh distribution in 2017
Was there a rollover?
If YES, please indicate the rollover amount.
Rollover?
Yes
No
$
Parent(s)
Rollover Amount
CERTIFICATION: (Provide required signatures and PUID)
Sign and date this form certifying that the information provided is complete and correct.
Student Signature: ______________________________________ Date: ____________
PUID: ______________________________________________
Parent Signature: _______________________________________ Date: ____________
Office Use Only – RRAAREQ: ______IRAP20 (R)
Hammond Campus
2200 169th Street * Hammond, IN 46323
(219) 989-2301 * FAX: (219) 989-2141
Westville Campus
1401 S. U.S. Hwy. 421 * Westville, IN 46391
(219) 785-5460 * FAX: (219) 785-5653
Toll-Free: 1-855-608-4600
website: pnw.edu
