PURDUE
UNIVERSITY
®
NORTHWEST
OFFICE OF FINANCIAL AID
IRA/Keogh Follow-Up Form 2020-2021
(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 2018. Further
processing of your financial aid will not occur until the information requested below has been received by the Office of
Financial Aid.
Rollover?
Parent(s)
Rollover Amount
According to your parent(s) IRS Tax Transcript, your parent(s)
received an IRA/Keogh distribution in 2018.
Was there a rollover?
If YES, please indicate the rollover amount.
Yes
No
$
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: ______VPIK21 (R)
Hammond Campus
2200 169
th
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
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