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University of the Incarnate Word Office of Financial (University of the Incarnate Word)

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(two-sided document)
University of the Incarnate Word
Office of Financial Assistance
2021-2022 Means of Support Form
4301 Broadway, Box 308
San Antonio, TX 78209
Phone: (210) 829-6008
Fax: (210) 283-5053
finaid@uiwtx.edu
www.uiw.edu/finaid
Revised 12/2020
(Black Ink Only)
Student Name: ID Number:
Address: City/State/Zip: Phone:
Y
ou indicated on your FAFSA that you are independent due to having children and/or legal dependents whom you
support more than 50%, as defined by the Internal Revenue Service (IRS). Please complete the information below.
1. Please list the following information for each child/legal dependent whom you support (attach a separate sheet if
more room is needed):
Name
Age
Relationship to You
Claimed on 2019 tax return?
[ ] Yes [ ] No
[ ] Yes [ ] No
[ ] Yes [ ] No
[ ] Yes [ ] No
[ ] Yes [ ] No 2. Did you work in 2019?
3. Did you file a federal tax return for 2019? [ ] Yes [ ] No
• If Yes, you must utilize the DRT process to transfer your tax information into your FAFSA, if you have not
already done so; OR provide an IRS Tax Return Transcript for 2019. You may request the transcript at
www.irs.gov.
• If No, you must provide copies of all 2019 W2s.
4. Do you currently work? [ ] Yes [ ] No
If Yes, Name of Employer
Current Monthly Earnings
5. P
lease indicate any applicable source(s) of other income, and monthly amount(s) – do NOT include financial aid.
Source
Applicable?
Child Support
[ ] Yes [ ] No
Cash Support from Family/Other person
[ ] Yes [ ] No
Government Assistance – WIC or SNAP
[ ] Yes [ ] No
Government Assistance – Housing/Other
[ ] Yes [ ] No
Other (please list):
[ ] Yes [ ] No
CODE: SUPP02
(two-sided document)
6. Please list monthly amounts for any/all expenses you are currently required to pay. If not applicable, indicate $0.
Expense
Monthly Cost (or N/A)
Amount You Pay
Housing (rent or mortgage)
Food (groceries, etc.)
Personal Expenses (clothes, entertainment, etc.)
Utilities (water, electricity, phone, internet, etc.)
Vehicle Costs (payments, insurance, gas, etc.)
Insurance (health, home, etc.)
Debt (credit card, loans, etc.)
Other obligations (please list):
7. Please give a brief description of your current financial, living, and transportation circumstances. You may attach a
sep
arate sheet, if necessary.
After review of the information above, we will determine whether your situation meets the definition of support as defined
by the Internal Revenue Service. A denial of the independent status will require that you correct your FAFSA to include
parent information and a parent signature. Decisions made by the Office of Financial Assistance as to your dependency
status are final.
St
udent Certification:
I certify that the information above is true and correct. Additionally, I understand that I am responsible for returning all
financial aid monies received due to inaccurate, false, or misleading information provided on this form.
Student Signature: Date:
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Completed 2 February 2021

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