A. Student
Information
Last Name First Name M.I. Social Security Number
Address (include apt. #) City State Zip Code
Date of Birth
Banner ID Number Phone
Number (include area code)
B. Family
Information
Independent
Students: List
the people in your household; include (a) yourself, your spouse if married; (b)
your children, if you provide more than half of their support from July 1, 2010
through June 30, 2011; and (c) any other people if they now live with you, and
you provided more than half of their support and will continue to provide more
than half of their support from July 1, 2010 through June 30, 2011. Also write
in the name of the college for any family member who will be attending college
at least half time between July 1, 2010 and June 30, 2011.
Dependent
Students: List
the people in your parentÕs household; include (a) yourself, (b) your parent(s) you live with
(include stepparent); (c) your parentsÕ other children, even if they donÕt live
with your parent(s), if (1) your parents provide more than half of their
support from July 1, 2010 through June 30, 2011, or (2) if they would be
required to provide parental information when applying for Federal student aid;
and (c) any other people if they now live with your parents, and your
parents provided more than half of
their support and will continue to provide more than half of their support from
July 1, 2010 through June 30, 2011. Also write in the name of
the college for any family member, excluding your parent(s), who will be
attending college at least half-time between July 1, 2010 and June 30, 2011,
and will be enrolled in a degree program.
If you need more space, attach a separate page.
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Example:
Martha Jones
24
Wife
City University |
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Self |
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OVER—Second Page must be Completed
and Signed |
C. Student (& Spouse) Tax Forms (all applicants)
Check one box only. Tax returns include the 2009 IRS Form
1040, 1040A, 1040EZ, a tax return from Puerto Rico or a foreign income tax
return. If you did not keep a copy
of the tax return; request a copy from your tax preparer or from the IRS at
1-800-829-1040.
□
Check & attach SIGNED tax
return(s) – No schedules or additional forms required.
□
Check here if you (& your spouse) will not file & are not required to
file a 2009 Federal Income Tax Return. See
Section E below.
D. Parent(s) Tax Forms and Income Information
(dependent students)
Check one box only. Tax returns include the 2009 IRS Form 1040, 1040A, 1040EZ, a
tax return from Puerto Rico or a foreign income tax return. If your parent(s) did not keep a copy
of the tax return, request a copy from the tax preparer or from the IRS at 1-800-829-1040.
□
Check & attach SIGNED tax
return(s) – no schedules or additional forms required.
□
Check here if your parent(s) will not file & are not required to file a 2009
Federal Income Tax Return.
See Section E below.
E. Untaxed Income (all applicants)
Both tax filers and non-tax
filers must list any untaxed income received in 2009. Be sure to enter zeros if no funds were received. Failure to complete this section will
delay the processing of your financial aid.
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Student(&
Spouse) |
Calendar Year 2009
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Parent(s) (Step-Parent) |
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All Earned Income not reported to the IRS
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$ |
Source:
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$ |
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$ |
Source: |
$ |
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FAFSA 2009 Untaxed Income
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$ |
Payments to tax-deferred
pensions and savings plans (paid directly or withheld from earnings)
including amounts reported on W-2 Form Box 12a-12d, codes D,E,F,G,H & S |
$ |
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$ |
Child support received for
all children. Do not include foster care or adoption payments. |
$ |
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$ |
Housing, food, & other
living allowances paid to members of the military, clergy and others
(including 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. |
$ |
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$ |
Veterans noneducation
benefits such as Disability, Death Pension, or Dependency & Indemnity
Compensation (DIC) and/or VA Educational Work-Study allowances. |
$ |
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$ |
Other untaxed income not
reported elsewhere such as workersÕ compensation, disability, IRAÕs, tax
exempt interest, untaxed pensions, etc. Do not include
student aid, earned income credit, child tax credit, WIA benefits, or
benefits from flexible spending arrangements, e.g. cafeteria plans. |
$ |
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$ |
Money received, or paid on
your behalf not reported elsewhere. |
$ |
F.
Sign this Worksheet
By signing this worksheet, I (we) certify that all the information reported on this worksheet is complete and correct. If dependent, at least one parent must sign. WARNING: If you purposely give false or misleading information on the worksheet, you may be fined, sentenced to jail, or both.
_________________________________________ _______________________________________________
Student Signature Date Parent Signature (Dependent students only) Date
Return to: Financial Aid Office at Cayuga Community College