Fillable 2014-2015 Non-Tax Filer/income Statement Template

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2014-2015 NON-TAX FILER / INCOME STATEMENT – PARENT(s)

RETURN TO:

Student Last Name:

CAL POLY

FINANCIAL AID OFFICE

Student First Name:

SAN LUIS OBISPO, CA 93407-0201

FAX: (805) 756-7243

Phone #

EMPL ID#:

financialaid@calpoly.edu

DEADLINE: All forms should be submitted as soon as possible. Documents must be submitted no later than June 30, 2014 to keep FWS, SEOG, and Perkins.

In all circumstances documents must be submitted prior to the last day of a student’s enrollment for any aid.

The Department of Education has selected your student’s FAFSA for review in a process called Verification. In this process

we will be comparing information from your FAFSA with information we are collecting on this form. Please review the IRS

tax filing requirements (listed on page 2) and check & sign in the appropriate space below.

For Office Use Only

2013 IRS Tax Filers:

This form does NOT apply because I/we are required to file 2013 taxes (based on IRS Tax Filing

Requirements listed on page 2). I/we will follow the instructions to have our tax data submitted to

Cal Poly Financial Aid Office.

I certify that all the information reported on this form is true. False statements or misrepresentation will be

cause for denial, reduction, withdrawal, and/or repayment of financial aid.

_____________________________________________________

Initials _______

Parent Signature (required if checked box above)

Date

NON-TAX FILERS: PLEASE COMPLETE THIS INFORMATION ABOUT YOUR PARENT(S) 2013 INCOME

Do not leave any income items blank. Enter zero ($0) under “Amount Earned” if you did not work and/or had no income. See IRS Grid on

following page for income filing requirements. Signatures required below.

Check all that apply:

Father

Mother

Did not work in 2013.

Father

Mother

Worked in 2013.

List below each employer and any other sources and amounts of earned income during 2013. Submit copies of all W-2’s

FATHER (STEPFATHER):

Name of Employer / Income Source:

Amount Earned:

W-2’s must

be attached

MOTHER (STEPMOTHER):

Name of Employer / Income Source:

Amount Earned:

W-2’s must

be attached

SIGN and DATE:

I certify that all information reported on this form and any attachment is complete, true, and accurate. I certify that I/we are not

required to file a 2013 Federal Income Tax Return. I/we have not/will not file a 2013 Federal Income Tax Return

(based on IRS Tax Filing Requirements).

False statements or misrepresentation will be cause for denial, reduction, withdrawal,

and/or repayment of financial aid.

_________________________________________________

Parent Signature (required)

Date

(no electronic signatures)

FNFP15

2014-2015 Non-Tax Filer/income Statement Template - Parent(S)

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