Fillable PURDUE NORTHWEST Pension/Annuity Follow-Up Form 2020-2021 (Student) (Purdue University Northwest)

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PURDUE NORTHWEST Pension/Annuity Follow-Up Form 2020-2021 (Student) (Purdue University Northwest)

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PURDUE
UNIVERSITY
®
NORTHWEST
Pension/Annuity Follow-Up Form 2020-2021
(Student)
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 you (and/or your spouse, if married) received a Pension/Annuity 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?
Student/Spouse
Rollover Amount
According to your IRS Tax Transcript, you (and/or your spouse, if
married) received a Pension/Annuity 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: ______________________________________________
Spouse Signature: _______________________________________ Date: ____________
Office Use Only – RRAAREQ: ______VSPA21 (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
finaid@pnw.edu pnw.edu
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PURDUE NORTHWEST PensionAnnuity Follow-Up Form 2020-2021 (Student) (Purdue University Northwest)

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Completed 21 July 2020

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