Domestic Partnership Status Form For Parents - Office Of Financial Aid (Page 2 of 3) in pdf

2012-13

Domestic Partnership Status - Parent

Student Name:

UCI ID #:

(print)

Last, First, Middle Initial

Complete these questions using the partner’s information that is not currently included on your FAFSA. Report only information that

has not been reported on the FAFSA. Make sure that the student, parent and partner sign the form.

Partner Name: _______________________________________________________________________

Last

First

Month and year partnership was established:

_________/_________

How many people are in your household?

_________

How many people in your household will be college students between July 1, 2012 and June 30, 2013? ________

For 2011, has your partner completed their IRS income tax return or another tax return?

_______

My partner has already completed their return.

_______

My partner will file, but they have not yet completed their return.

_______

My partner is not going to file. Skip question 6.

What income tax return did your partner file or will they file for 2011?

_______IRS 1040

_______IRA 1040A, 1040EZ

_______A foreign tax return

_______ A tax return with Puerto Rico, American Samoa, the U.S. Virgin Islands, the Marshall Islands, the Federated States

of Micronesia, or Palau.

Don’t Know

If your partner filed or will file a 1040, were they eligible to file a 1040A or 1040EZ?

Yes

Did your parent receive benefits from any of the following federal programs in 2011?

 Supplemental Security Income (SSI) Program (indicate SSI amount received in Section IV below)

 Food Stamp Program

 Free or Reduced Price School Lunch Program

 Temporary Assistance for Needy Families (TANF) (indicate TANF amount received in Section IV below)

 Special Supplemental Nutrition Program for Women, Infants & Children (WIC)

What was your partner’s adjusted gross income for 2011?

$________________

Adjusted gross income is on IRS Form 1040 – line 37; 1040A – line 21; 1040EZ – line 4.

Enter the total amount of your partner’s income tax for 2011.

10.

$________________

Income tax amount is on IRS Form 1040 – line 61; 1040A – line 35; 1040EZ – line 10.

Enter your partner’s exemptions for 2011.

12.

_________________

Exemptions are on IRS Form 1040 or 1040 A – Line 6d; 1040EZ see the FAFSA instructions, page 2

13.

How much did your partner earn from working (wages, salaries, tips, etc)

in 2011? Answer this question whether or not your partner completed a tax return.

$________________

14.

As of the day the FAFSA was completed, what was the total balance of cash, savings

and checking accounts?*

$________________

As of the day the FAFSA was completed, what was the net worth of the partner’s

15.

investments, including real estate (not the family home)? Net worth means current

value minus debt. *

$________________

As of the day the FAFSA was completed, what was the net worth of the partner’s current business and/or investment farms?

16.

Do not include a farm that the family live on and operate.

$________________

*Refer to page 4 of the FAFSA for further directions and information.

2/15/2012

Domestic Partnership Status Form For Parents - Office Of Financial Aid Page 2

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