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
–
Parent(s) –
2018/2019
ADFP17
_____________
____________________________________________
700____________________________________
Student's Name (please print) UCM ID Number
Federal regulations require verification of certain responses that were entered on your student’s 2018/2019
Free Application fo
r 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 support you (the parent) 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
................................................................. $________________
Names an
d ages of children for whom this child support was paid:
________________________________________________________________________________
________________________________________________________________________________
Educational credits claimed. Refer to your (the parent’s) 2016 federal
tax ret
urn for this amount (1040 – line 50 or 1040A – line 33). ........................... $________________
Grant and scholarship assistance reported as part of your (the parent’s)
2016 federal Adjusted Gross Income. Refer to your (the parent’s) 2016
federal tax return for this amount. ....................................................................... $________________
Taxable Combat (or Special Combat) Pay included in your (the parent’s)
2016 federal Adjusted Gross Income. This amount is
normally $0 for enlisted
persons and warrant officers. Attach to this worksheet photocopies of your
(the parent’s) 2016 W-2(s) and your Leave and Earnings Statement(s). ............ $________________
Total for the 2016 12-month calendar year ................................... $________________
_______________________________________________ _______________________________
Parent's Signature Date
_______________________________________________ _______________________________
Student's Signature Date
This document, and your parent(s)’ 2016 IRS Tax Return Transcript(s), if not already on file with UCM, must
be submitted to the Office of Student Financial Services in person (1100 Ward Edwards Bldg,), or by mail
(University of Central Missouri, Office of Student Financial Services, P.O. Box 800, 1100 Ward Edwards
Bldg, Warrensburg MO 64093, or by fax (660-543-8080).
Parent_Addl_Fin_Info_18.pdf NOV 3, 2017
