midlandstech.edu/eoc
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PO Box 2408
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Columbia, SC 29202
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803.822 .3749
EDUCATIONAL OPPORTUNITY CENTER
PARENTAL INCOME VERIFICATION FORM
EOC is a federally funded TRiO program and is required by the U.S. Department of Education to obtain income information for
participants and their parents, if they are dependent. Unless you are 24 years old, you are considered a dependent student.
Exceptions to this rule include: 1) you are married: 2) you have children or legal dependents who you provide more than 50%
of their support; 3) you are a veteran or serving active duty military 4) you are an orphan or ward of the court; 5) since turning
13, both of your parents were deceased; 6) you are in a legal guardianship; or 7) a financial aid administrator has determined
you are independent. Otherwise, it is important that you and your parents fully complete the form below or provide a copy of
your and your parents’ tax returns (1040, 1040A, or 1040EZ) for the current year. If your parents are currently married (including
legal same sex marriages and stepparents) or living together, income information for both parents is required. All financial
information will be kept confidential and will only be used for federal reporting purposes.
Student Name Student Social Security Number
Parent Name(s) Parent Phone Number
Parent Address Relationship to the Student
PARENT EDUCATION INFORMATION
Did the participant’s MOTHER graduate from college with a four-year degree?
YES
NO
UNKNOWN
Did the participant’s FATHER graduate from college with a four-year degree?
YES
NO
UNKNOWN
PARTICIPANT INCOME INFORMATION
Did you complete an IRS income tax return? YES NO TAX YEAR
What is your adjusted gross income? $
What is your taxable income (if you filed a tax return)? $
As of today, are you currently a dislocated worker? YES NO
PARENT INCOME INFORMATION
Did parent(s) complete an IRS income tax return? YES NO TAX YEAR
What is parents’ adjusted gross income? $
What is parents’ taxable income (if you filed a tax return)? $
As of today, is either parent currently a dislocated worker? YES NO
How many people are in the parent(s)’ household?
How many will be in college during the award year (not including parents)?
Adjusted gross income (AGI) includes
the amount of money earned in a year
from working, wages, and tips. Use the
box on the back of this form to locate your
AGI on your tax return.
Taxable income is the amount of
income the federal government will
actually tax. Use the box on the back of
this form to locate your taxable income
on your tax return.
You are considered a dislocated worker
if you have been laid off from a job, are
currently receiving unemployment
benefits, or are a displaced homemaker.
The household size is the number of
people for whom the parent provides more
than 50 percent of their support for the
entire award year (see award year below
for clarification). This may include people
who live in the home, children who live
outside the home, and unborn children
who will receive more than half of the
parents’ support during the award year.
An
award year
begins July
1
of the first year
and ends June 30 of the second year. For
example, the 201
7
-1
8
award year is July
1,
201
7
– June 30, 201
8
.
