University of Central Missouri
Office of Student Financial Services
P.O. Box 800
Warrensburg, MO 64093-5178
Phone 660-543-8266
FAX 660-543-8080
Webpage: www.ucmo.edu/sfs
Additional Financial
Information Worksheet
– Student –
2018/2019
____________________________________________
ADFS17
700_______________________________
Student’s Name (please print) UCM ID Number
Federal regulations require verification of certain responses you entered on your 2018/2019 Free Application
for Federal Student Aid (FAFSA). Please provide the following information and submit this document to the
UCM Office of Student Financial Services.
Provide the total amounts for the 2016 twelve-month
calendar year (January through December):
Total child suppo
rt you (and/or your spouse, if married) paid to another
person during the 2016 calendar year due to a divorce or separation or as a result
of a legal requirement. If none, enter $0. ................................................................... $__________________
N
ames and ages of the children for whom this child support was paid:
_____
____________________________________________________________________________
_________________________________________________________________________________
Educational credits claimed
. Refer to your/your spouse’s 2016 federal
tax return(s) for this amount (1040 – line 50 or 1040A – line 33) ........................ $__________________
Grant and scholarship assistance reported as part of your 2016 Adjusted
Gross Income. Refer
to your/your spouse’s 2016 federal tax return(s)
for t
his amount ....................................................................................................... $__________________
Taxable Combat (or Special Combat) pay
included in your/your spouse’s
2016 federal Adjusted Gross Income. This amount is normally $0 for enlisted
persons and warrant officers. Attach to this worksheet photocopies of your/your
spouse’s 2016 W-2(s) and Leave and Earnings Statement(s).
.............................. $__________________
Total for the 2016 12-month calendar year ........................................... $__________________
_______________
_______________________________________ _______________________________
Student’s Signature Date
_______________
_______________________________________ _______________________________
Spouse’s Signature (if student is married) Date
This document and your (and your spouse’s) 2016 IRS Tax Return Transcript(s), if not already on file
with UCM must be faxed (660-543-8080), brought to our office (1100 Ward Edwards Bldg.), or mailed to
our office (University of Central Missouri, Student Financial Services, P.O. Box 800, 1100 Ward
Edwards Bldg. Warrensburg MO 64093-5178).
Student_Addl_Fin_Info_18.pdf NOV 3, 2017
