Pension/Annuity Follow-Up Form 2020-2021
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.
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.
CERTIFICATION: (Provide required signatures and PUID)
Sign and date this form certifying that the information provided is complete and correct.
Student Signature: ______________________________________ Date: ____________
Spouse Signature: _______________________________________ Date: ____________
Office Use Only – RRAAREQ: ______VSPA21 (R)
Street Hammond, IN 46323
(219) 989-2301 fax (219) 989-2141
1401 S. U.S. Hwy. 421 Westville, IN 46391
(219) 785-5460 fax (219) 785-5653