R Student Rocket Number Student Last Name Student First Name COMPLETE WITH BLACK INK ONLY. 2014-15 PARENT EXPENSE AND INCOME WORKSHEET The income reported on your 2014-2015 Free Application for Federal Student Aid (FAFSA) does not appear sufficient to meet your basic living expenses (i.e., housing, utilities, food, etc.). In order for the processing of your federal financial aid application to continue, please complete and return this form to the Office of Student Financial Aid. WHO IS YOUR PARENT? Additional guidance for dependent students:  If your parent was never married and does not live with your other legal parent, or if your parent is widowed or not remarried, answer the questions about that parent.  If your legal parents (biological and/or adoptive) are not married to each other and live together, you must provide information about both of them regardless of their gender. Do not include any person who is not married to your parent and who is not a legal or biological parent.  If your legal parents are divorced but living together, you must report information about both of them.  If your parents are divorced or separated, answer the questions about the parent you lived with more during the past 12 months. If you did not live with one parent more than the other, give answers about the parent who provided more financial support during the past 12 months or during the most recent year that you actually received support from a parent. If this parent is remarried as of today, answer the questions about that parent and that parent’s current spouse. List below all expenses incurred by your parent(s) in 2013. 2013 Parent Expenses Annual Amount from January 2013 through December 2013 Rent or mortgage payment $ x 12 months = $ total per year Car payment $ x 12 months = $ total per year Car fuel and maintenance $ x 12 months = $ total per year Groceries $ x 12 months = $ total per year Medical, vision, dental insurance $ x 12 months = $ total per year Out of pocket medical expenses $ x 12 months = $ total per year Clothing expenses $ x 12 months = $ total per year Child care expenses $ x 12 months = $ total per year Natural gas or fuel oil bill $ x 12 months = $ total per year Electric bill Regular telephone and/or cellular telephone bill $ $ x 12 months = $ x 12 months = $ total per year total per year Cable TV bill $ x 12 months = $ total per year Internet provider bill $ x 12 months = $ total per year Recreation/entertainment $ x 12 months = $ total per year Miscellaneous personal expenses $ x 12 months = $ total per year Court ordered child support paid $ x 12 months = $ total per year Other (specify) Total living expenses for the entire year 2013 $ $ x 12 months = $ x 12 months = $ total per year total per year Did your parent(s) earn any income from work in 2013? Yes No Did your parent(s) receive any 2013 W-2s and/or 1099s for income earned from work? Yes No If “Yes,” provide copies of all parent(s) 2013 W-2s and 1099s, even if they were not required to file a federal income tax return for 2013. Continue on the back. R Student Rocket Number Student Last Name Student First Name Indicate below if your parent(s) received benefits from any of the following programs in 2012 or 2013.  Yes  Yes Subsidized/public housing (HUD) benefits Women, Infants, and Children Program (WIC) benefits Supplemental Nutrition Assistance Program (SNAP) benefits (formerly known as Food Stamps)  No  No  Yes  No List SNAP recipients’ relationship to student: List names of persons who received SNAP benefits in 2012 or 2013: 1. 2. 3. Your parent(s) may have additional resources other than earnings from employment. If so, some types of resources must be considered when determining your federal financial aid eligibility. List below amounts for all forms of additional resources received by your parent(s) in 2013. 2013 Parent Income/Resources Annual Amount from January 2013 through December 2013 Income from work (gross amount) $ x 12 months = $ total per year Spouse’s income from work (gross amount) $ x 12 months = $ total per year Resources from parents or relatives $ x 12 months = $ total per year Resources from boyfriend/girlfriend $ x 12 months = $ total per year Resources from partner/life partner $ x 12 months = $ total per year Unemployment benefits $ x 12 months = $ total per year Disability benefits $ x 12 months = $ total per year Child support received $ x 12 months = $ total per year Business, rental, or farm income $ x 12 months = $ total per year Trust fund income $ x 12 months = $ total per year Interest/dividend income $ x 12 months = $ total per year Social Security retirement benefits $ x 12 months = $ total per year Social Security Disability benefits (SSI) $ x 12 months = $ total per year Public assistance (including TANF) $ x 12 months = $ total per year Free or reduced price lunch for children $ x 12 months = $ total per year Subsidized housing income $ x 12 months = $ total per year SNAP benefits (Food Stamps) $ x 12 months = $ total per year Veteran’s benefits (non-education) $ x 12 months = $ total per year Financial aid refund $ x 12 months = $ total per year Other (specify) $ x 12 months = $ total per year Total income and resources for the entire year 2013 $ x 12 months = $ total per year Please add any clarifying comments regarding your situation that will help with our review. If your total 2013 expenses are greater than your total 2013 income, you are required to provide an explanation below: Certification Statement: By signing this worksheet, I (we) certify that all of the information reported on this worksheet, used to determine eligibility for federal financial aid, is complete and correct. WARNING: If you purposely give false or misleading information on this worksheet, you may be fined, sentenced to jail, or both. RETURN TO: Parent Signature Date Student Signature Date Questions? Please contact Rocket Solution Central (RSC) at 419.530.8700. PINEXP The University of Toledo Office of Student Financial Aid 2801 W. Bancroft St., Mail Stop 314 Toledo, OH 43606-3390 *** Faxed documents will not be accepted.***