If this document is not accessible, contact Disability Services at 910.788.6327, disabilityservices@sccnc.edu, or in A-124.
E. Other untaxed income received by student or parent:
List the amount of other untaxed income not reported and not excluded elsewhere on this form. Include untaxed income such as
workers’ compensation, disability, Black Lung Benefits, untaxed portions of health savings accounts from IRS Form 1040 Line 25,
Railroad Retirement Benefits, etc.
Do not include any items reported or excluded in A – D above. In addition, do not include student aid, Earned Income Credit,
Additional Child Tax Credit, Temporary Assistance to Needy Families (TANF), untaxed Social Security benefits, Supplemental
Security Income (SSI), Workforce Investment Act (WIA) educational benefits, combat pay, benefits from flexible spending
arrangements (e.g., cafeteria plans), foreign income exclusion, or credit for federal tax on special fuels.
Name of Recipient
Type of Other
Untaxed Income
Amount of Other Untaxed
Income Received in 2018
F. Money received or paid on the student’s or parents’ behalf:
List any money received or paid on the student’s or parents’ behalf (e.g., payment of bills such as rent, utility bills, etc.) and not
reported elsewhere on this form. Enter the total amount of cash support received in 2018. For example, if someone is paying rent,
utility bills, etc., for the student’s parent or provides cash, gift cards, etc., include the amount of that person's contributions. Do not
include as student’s untaxed income any support from a parent whose information was reported on the 2020-2021 FAFSA.
Amounts paid on the student’s behalf also include any distributions to the student from a 529 plan owned by someone other than
the student or the student’s parents, such as grandparents, aunts, and uncles of the student.
Purpose: e.g., Cash, Rent, Books Amount Received in 2018 Source
Additional information:
So that we can fully understand the student’s family's financial situation, please provide below information about any other
resources, benefits, and other amounts received by the student and parents or any members of the student’s household. This may
include items that were not required to be reported on the FAFSA or other forms submitted to the financial aid office, and include
such things as federal Veterans education benefits, military housing, SNAP, TANF, etc.
If more space is needed, provide a separate page with the student’s name and ID number at the top.
Name of Recipient
Type of
Financial Support
Amount of Financial Support
Received in 2018
Comments:
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
Certification and Signature
I certify that all of the information reported on this worksheet is
complete and correct. The student must sign this worksheet.
____________________________________________________________
Student’s Signature and Date
____________________________________________________________
Parent’s Signature and Date
WARNING: If
ou
ur
osel
ive false or misleadin
information on this worksheet
ou ma
be fined
be sentenced to
ail
or both.
