Non Taxable Income Worksheet Template
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1FR/SUM
Income Exclusion Worksheet - P
ARENT
A
Y
2015-2016
CADEMIC
EAR
Student Name: ________________________________________________________________________________
Last Four Digits of SSN: XXX - XX -_______
Student ID # (if applicable): _____________________
I certify the information provided on this form is true and complete to the best of my knowledge.
Student Signature: _________________________________________________
Date: _________________
Parent Name: _____________________________________________________
Parent Signature: __________________________________________________
Date: _________________
To confirm your 2015-2016 financial aid eligibility, our office requires additional information about your parent(s) 2014
income. Please have your parent(s) complete the information below and submit this form to our office. Respond to all
questions. Incomplete forms will not be processed and will be returned to you for clarification.
►►If the answer is zero, please indicate ‘0’ or ‘N/A’. We are not able to accept blank as an answer.
Yearly Amount Received
SECTION I: Check here
if you (the parent) did not file and were not required to file a 2014 tax
(Jan 1, 2014– Dec 31, 2014)
form. Report your total 2014 income earned from work below AND complete SECTION III.
DO NOT LEAVE BLANKS
Parent 1 (father/mother/stepparent)
$________________.00
Parent 2 (father/mother/stepparent)
$________________.00
SECTION II: Check here
if you (the parent) have filed your 2014 tax form. REMINDER: Please send our office a signed copy including
any schedules (A, C, D, E, etc.) and all W2 forms (foreign tax forms must be signed, translated, and converted to U.S. Dollars) AND
complete SECTION III.
Yearly Amount Received
SECTION III: Report your Income Exclusions source for you (the parent) below.
(Jan 1, 2014– Dec 31, 2014)
DO NOT LEAVE BLANKS
Grants or Scholarships as reported on your parent(s) 2014 federal
$________________.00
tax form (1040, 1040A, 1040EZ)
Your parent(s) taxable earnings from federal or state work study programs
$________________.00
Taxable Combat pay included in your parent(s) AGI on the 2014 federal tax form (1040, 1040A,
$________________.00
1040EZ)
$________________.00
Your parent(s) AmeriCorps awards, living allowances, or interest accrual payments
Your parent(s) Earnings from work under a cooperative education program offered by a college
$________________.00
Child Support PAID for 2014 (don’t include support paid for the children reported in your parents’
FAFSA household size):
Name and age of child(ren) child support paid for: __________________________________________
_________________________________________
$________________.00
_________________________________________
_________________________________________
Name of parent child support paid to: _________________________________________
18115 Campus Way NE, Box 358500 Bothell, WA 98011-8246 ● Phone: (425) 352-5240 ● Fax: (425) 352-3217
Office Hours: Monday – Friday 8:00 am to 5:00 pm ● Website:
● Email:
uwbfaid@uw.edu
MAR/2015
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