____________________________________________ ________________
Taxpayer ID Number for 1098T
Part I.
1. Enter your name and mailing address. The name should match that used by the Social Security
Administration or Internal Revenue Service.
2. Taxpayer identification number; Enter your SSN or ITIN. If you do not have an SSN or ITIN, apply for one
and fill out and return this form when you receive it.
PART I
Name of Student
Address
Taxpayer Identification Number
(SSN or ITIN)
__ __ __ - __ __ - __ __ __ __
Purdue University Id Number
P
ART II
Part II. Sig
n your name in the space provided to confirm the information provided. The Office of the Registrar
cannot change your records without your signature.
I certify that the number shown on this form is my correct taxpayer identification number.
Sig
nature Date
Part III.
□
OR
PART III
Please fill out this part only if you are unwilling or unable to provide a taxpayer identification number.
Check either the first or second box, and sign the statement. By law, Purdue University Northwest must ask you at
least once a year for your taxpayer identification number in order to meet its obligation to file Form 1098-T.
I am a foreign national/nonresident alien and do not have a Social Security number or individual
taxpayer identification number. I do not plan to file an income tax return in the U.S.
□ I do not wish to provide my taxpayer identification number to Purdue University Northwest at
this time. I understand that I may be subject to an IRS fine of $50 for failure to do so. I further
understand that the IRS will not be able to use the Form 1098-T filed by Purdue University
Northwest to confirm my eligibility for certain education tax benefits without my taxpayer
identification number.
____________________________________________ ________________
Signature Date
Delivery of Form. If you have not previously provided your SSN, ITIN, or declared that you are a foreign
national/nonresident alien, please fill out this form and deliver or mail the completed form to one of the following
addresses: Bursar’s Office, Purdue University Northwest, Lawshe Hall, Room 130G, 2200 169
th
Street, Hammond,
IN 46323 or Bursar’s Office, Purdue University Northwest, Schwarz Hall, Room 127, 1401 S US Hwy 421,
Westville, IN 46391. Do not email the form. Email is not a secure way to transmit personal information.
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