Fillable form to the Financial Aid Office to continue (Virginia Western Community College)

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form to the Financial Aid Office to continue (Virginia Western Community College)

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The form to the Financial Aid Office to continue (Virginia Western Community College) form is 2 pages long and contains:

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Country of origin: US
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U.S.A. forms for Virginia Western Community College

BROWSE VIRGINIA WESTERN COMMUNITY COLLEGE FORMS

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2020-2021 Parent Untaxed Income Form
The U.S. Department of Education selected your student’s 2020-2021 FAFSA for review after comparing your 2018 Adjusted
Gross Income and other untaxed income. You and your spouse, if you are married, must complete form. You and your
student must print, sign, and submit the form. Instructions for submission are at the end of the form.
You and your spouse, if you are married, must complete this form. One parent and the student must sign and submit this
form to the Financial Aid Office to continue the verification review process.
A. Student Information
B. Untaxed Income Information
Report total annual amounts for 2018. If an item does not apply, enter “0” or “N/A.” Boxes left blank will result in additional information requested.
Additional requests to clarify conflicting information may delay the determination of your student’s financial aid eligibility. If more space is needed
provide a separate page with your student’s name and student ID number at the top.
First Name
MI
Last Name
VWCC Student ID - Required
Untaxed Income Item to Verify:
Parent Name(s) for whom the information below is being reported (first and last
name(s)
Parent One:
Total 2017 Amount:
Parent Two:
(if Parent is married)
Total 2017 Amount:
Parent One Name:
Payments made to tax-deferred pension and retirement savings plans. List any
payments (direct or withheld from earnings) to tax-deferred pension and retirement savings
plans (e.g., 401(k) or 403(b) plans), including, but not limited to, amounts reported on W-2
forms in Boxes 12a through 12d with codes D, E, F, G, H, and S.
$
$
IRA Deductions & payments to self-employed SEP, SIMPLE, Keogh, and other
qualified plans. List the total amounts from IRS 1040 Schedule 1 – Total of lines 28 + 32.
$
$
Child Support Received. List actual amount received in 2018 for any children in your household. If additional space is needed attach a separate
piece of paper with required information. Do not include foster care payments, adoption payments, or court-order amounts not actually paid.
LIST NAME OF CHILD(REN):
$
$
$
$
Payment:
Untaxed Portions of IRA distributions and Pensions. List amount from IRS 1040 – line
4a minus line 4b. Exclude Rollovers. If the value is negative enter ‘0’.
$
$
Tax exempt interest income. List amount from IRS 1040 – line 2a.
$
$
C. Certification and Signatures
The student and one parent for whom information is provided above MUST sign and date this section. Each person signing below
certifies that all the information reported on this form is complete, correct, and any additional information is attached, if necessary.
WARNING: If you purposely give false or misleading information on this worksheet you may be fined, sentenced to jail, or both.
______________________________________________________________________ _______________
Student Signature Required Date
______________________________________________________________________ _______________
Parent Signature Required (If due to the current national situation your parent cannot Date
sign the form, complete section below)
My parent is not able to sign because_________________________________________________________________________
______________________________________________________________________________________ __________________
Student Initials Required
WAYS TO SUBMIT THIS FORM
(1) Upload this form directly into the Student Information System (SIS) by logging into MY VWCC. Once logged in, go to the
Student Center and select the ‘VWCC 19/20 Dependent # in Coll’ from the ‘To Do List’ list to attach and upload the form. (2)
Upload the form at www.virginiawestern.com
by clicking ‘Contact Us,’ and then clicking the 24/7 Student Support icon. Once
you log in you can submit documents. (3) Fax forms to 540-857-6208
♦
Phone: (855)874-6690 (Revised 04_2020)
Untaxed Income Item to Verify - CONTINUED:
Parent One:
Total 2018 Amount:
Parent Two:
(if Parent is married)
Total 2018 Amount:
Housing, food, and other living allowances paid to members of the military, clergy,
and others. Include cash payments and cash value of benefits. Do not include the value of
on-base military housing or the value of a basic military housing allowance (BAH).
$
$
Veteran’s non-education benefits. List the total 2018 amounts including disability, death pension, Dependency and Indemnity Compensation
(DIC), and/or VA Educational Work-Study allowances. Do not include federal veterans’ educational benefits like the Montgomery GI Bill,
Dependents Education Assistance Program, VEAP Benefits, or the Post 9/11 GI Bill.
TYPE OF BENEFIT:
$
$
TYPE OF BENEFIT:
$
$
Other items not reported above. Include items such as worker’s compensation, disability, Black Lung Benefits, untaxed portions of health
savings accounts from IRS 1040 Schedule 1 -- Line 25, Railroad Retirement Benefits, etc. Do not include student aid, earn income credit,
additional child tax credit, TANF, SNAP, SSI, 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.
SOURCE:
$
$
SOURCE:
$
$
First Name
MI
Last Name
VWCC Student ID - Required
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Completed 27 July 2020

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