St. John’s University Office of Student Financial Services Family Income and Expense Breakdown Student Name: __________________________________ ID Number X____________________________ Please return this form to our Processing Center: St. John’s University P. O. Box 548Randolph, MA 02368-0548 Federal regulations require us to verify how families of extremely low incomes support themselves. The income and expense information requested on this form pertains to your parent’s household (including yourself). If your parents live in another country, report the income and expense information converted to U.S. dollars. **Do not leave any blanks** 1) INCOME SECTION 2014 – List dollar amount and SUBMIT PROOF OF SOURCE OF INCOME/BENEFITS A. B. C. D. E. F. G. Income From Work Public Assistance [ ] TANF [ ] SNAP Social Security Benefits Relatives Child Support Received Unemployment Benefits Other Support Received Total Income for 2014 Year 2014 Year 2014 Year 2014 Year 2014 Year 2014 Year 2014 Year 2014 Year (Add lines A through G) $ $ $ $ $ $ $ $ 2) EXPENSES SECTION 2014 (If unusually low, please explain below) A. B. C. D. E. Check One: [ ] Rent [ ] Mortgage Utilities Food Transportation (gas, insurance) Other Expenses (please specify) Total Expenses for 2014 Year 2014 Year 2014 Year 2014 Year 2014 Year 2014 Year (Add lines A Through E) $ $ $ $ $ $ If your expenses exceeded your income, you must briefly explain how you met your expenses. You may also use these lines to explain unusually low expenses or any other special circumstances. 3) TAX FILING STATUS: ***** PLEASE SEND COPY AS ORIGINAL WILL NOT BE RETURNED***** Parent: Student:  Check & submit a signed copy of your 2014 Tax Return Transcript and 2014 W-2 form.  Check here if you will not file and are not required to file a 2014 U.S. Income Tax Return.  Check & submit a signed copy of your 2014 Tax Return Transcript and 2014 W-2 form.  Check here if you will not file and are not required to file a 2014 U.S. Income Tax Return. 4) CERTIFICATION: I (we) hereby attest that all the information on this form is accurate to the best of my (our) knowledge. I (we) understand that providing false or misleading information can jeopardize financial aid eligibility and subject me (us) to federal penalties. _____________________________________ Student’s Signature Date _____________________________________ Parent 1 Signature Date _____________________________________ Parent 2 Signature Date STJ_FA_INCBRA