VR
This form is to verify untaxed income reported on the FAFSA. These figures typically are not greater than the Adjusted
Gross Income (AGI) for the student or a parent of a dependent student. Please confirm the amounts for untaxed income
reported on the FAFSA. Independent Students: Do not include parent data.
University ID (UID) – Required.
Student Cell Phone Number
Student/Spouse
Amount for 2018
Parent(s’)
Amount for 2018
(only if student
is dependent)
Payments to tax-deferred pension and retirement savings.
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 and payments to self-employed SEP, SIMPLE
Keogh and other qualified plans.
Reported on IRS Form 1040 Schedule 1, Line 28 + Line 32.
Child Support received.
List the actual amount of any child support you received in 2018 for
children in your household.
Tax exempt interest income.
Reported on IRS Form 1040 Line 2a
Untaxed portions of IRA, Pension and Annuity distributions.
Reported on IRS Form 1040, line 4a minus line 4b.
Exclude rollovers. If amount is negative, enter zero in the box.
Housing, food, and other living allowances paid to members of the
military, clergy, and others.
Include cash payments and/or the cash value of benefits received.
Veteran’s non-education benefits.
List the total amount of Veterans non-education benefits received in 2018.
Include Disability, Death Pension or Dependency & Indemnity Comp. (DIC)
and/or VA Educational Work Study allowances.
Other untaxed income: worker’s compensation, disability, Railroad
Retirement Benefits, etc. Do not include: welfare, social security, SSI,
WIA educational benefits, financial aid or combat pay.
Money received or paid on the student’s behalf.
List any money received or paid on the student’s behalf in 2018 (e.g.,
payment of student’s bills) and not reported elsewhere on this form.
I (we) certify that all information entered is complete and correct. (Actual Signatures Required. Form may be emailed or faxed.)
Parent Signature (for dependent student)
2020-2021
Verification of Untaxed
Income Form
VRUTIO - Ver Untaxed Income
Raider Connect
130 Student Union
3640 Colonel Glenn Hwy.
Dayton, OH 45435-0001
Phone: 937-775-4000
FAX: 937-775-4410
raiderconnect@wright.edu
