College of DuPage Office of Student Financial Assistance Last Name: Student ID/SSN: 2014-2015 – V1 Worksheet Dependent First Name: M.I. A. Dependent Student’s Family Information - List below the people in your parent(s)’ household. Include:  Yourself and your parent(s) (including a stepparent) even if you don’t live with your parent(s).  Your parent(s)’ other children if your parent(s) will provide more than half of their support from July 1, 2014 through June 30, 2015, or if the other children would be required to provide parental information if they were completing a FAFSA for 2014–2015. Include children who meet either of these standards, even if they do not live with your parent(s).  Other people if they now live with your parent(s) and your parent(s) provide more than half of their support and will continue to provide more than half of their support through June 30, 2015. Include the name of the college for any household member, excluding your parent(s), who will be enrolled at least half time in a degree, diploma, or certificate program at an eligible postsecondary educational institution any time between July 1, 2014 and June 30, 2015. If more space is needed, attach a separate page with the student’s name and Student ID at the top. Full Name Age Relationship Name of Will be Enrolled at To you College Least Half Time Missy Jones (example) 18 Sister College of DuPage Yes 1. 2. 3. 4. 5. 6. B. Student and Parent Additional Income Information  In 2013 or 2014, did you or anyone in your household (those listed in Section A of this form) receive benefits from the Supplement Nutrition Assistance Program (SNAP)? YES NO C. Dependent Student’s 2013 Income Information to Be Verified – Check either “Yes” or “No” for each of the following below: Box C. YES NO Did you work at all/earn any income in 2013? - IF YOU SELECTED “NO” (you did not work or earn any income in 2013) skip down to section D. Did you file a Tax Return in 2013? Did you use the IRS Data Retrieval Tool when you completed your FAFSA? - (Information on obtaining your IRS Tax Return Transcript or information on additional filing statuses can be found at the following link: http://cod.edu/tuition/pdf/income_tax_information_14.pdf) Did you work but did not/will not file a 2013 Tax Return? - IF YOU SELECTED “YES” you must report all income earned in 2013 in the table on the next page. 14-15 V1 Worksheet Dependent 1 03/31/2014 Student’s Name: ID/SSN: ATTACH COPIES OF ALL 2013 IRS W-2 FORMS IF YOU DID NOT FILE Student W-2 Information Employer’s Name Suzy’s Auto Body Shop (example) 1. 2. 3. 2013 Amount Earned $2,000.00(example) IRS W-2 Attached? Yes(example) D. Parent’s Income Information to Be Verified— Check either “Yes” or “No” for each of the following below: Note: If two parents were reported in Section A of this worksheet, the instructions and certifications below refer and apply to both parents. If only one parent is listed, you must use information for the parent you listed on your FAFSA application. Box D. Did your parent(s) work at all/earn any income in 2013? - IF YOU SELECTED “NO” (your parent(s) did not work or earn any income in 2013) skip down to section E. Did your parent(s) file a Tax Return in 2013? Did your parent(s) use the IRS Data Retrieval Tool when you completed your FAFSA? - (Information on obtaining your IRS Tax Return Transcript or information on additional filing statuses can be found at the following link: http://cod.edu/tuition/pdf/income_tax_information_14.pdf) Did your parent(s) work but did not/will not file a 2013 Tax Return? - IF YOU SELECTED “YES” you must report all income earned in 2013 in the table below: YES NO Parent 1 Parent 2 Parent 1 Parent 2 Parent 1 Parent 2 Parent 1 Parent 2 Parent 1 Parent 2 Parent 1 Parent 2 Parent 1 Parent 2 Parent 1 Parent 2 ATTACH COPIES OF ALL PARENT’S 2013 IRS W-2 FORMS IF PARENT(S) DID NOT FILE Parent 1 W-2 Information Employer’s Name Suzy’s Auto Body Shop (example) 1. 2. 3. Parent 2 W-2 Information Employer’s Name Suzy’s Auto Body Shop (example) 1. 2. 3. 2013 Amount Earned $2,000.00 (example) IRS W-2 Attached? Yes (example) 2013 Amount Earned $2,000.00 (example) IRS W-2 Attached? Yes (example) E. Certification and Signatures Each person signing this worksheet certifies that all of the information reported on it is complete and correct. The student and one parent must sign and date. Student Signature WARNING: If you purposely give false or misleading information on this worksheet, you may be fined, be sentenced to jail, or both. Date Parent Signature Date PLEASE RETURN THIS FORM TO: College of DuPage, Office of Student Financial Assistance – SSC 2220 425 Fawell Blvd, Glen Ellyn, IL 60137 FAX: (630) 942-2151 EMAIL: [email protected] The college will not discriminate in its programs and activities on the basis of race, color, religion, creed, national origin, sex, age, ancestry, marital status, sexual orientation, arrest record, military status or unfavorable military discharge, citizenship status, physical or mental handicap or disability (Board Policy 5010; 20-5). 14-15 V1 Worksheet Dependent 2 03/31/2014