Adjusted Tax Form For Persons Who Filed Jointly - 2017-2018

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Student
Student ID or
Name _______________________________________
Star ID # _______________________________
2017-2018 Adjusted Tax Form for Persons Who Filed Jointly
Dependent Student
This worksheet is used when a student’s parent completed a tax form with a spouse whose income is not to be
considered when filing for financial aid. (Examples: parents filed jointly but are now separated/divorced; parents filed
jointly, but one of the parents is now deceased.) Copies of your parents’ 2015 federal tax form and all W-2 forms are
required with this application.
*Please explain why only one of your parents’ incomes should be used when filing for financial aid:
Information Taken from the 2015 Joint Federal Tax Form
Adjusted number of exemptions
____________________
Parent’s wages, salaries, tips (taken from W-2 forms)
____________________
50% taxable interest income
(+)
____________________
Other amounts entered on federal tax form as taxable income:
____________________
% used ____________ (+)
____________________
____________________
% used ____________ (+)
____________________
Adjustments that decreased your adjusted gross income on your original tax return: ie. IRA deduction
____________________
% used ____________ (-)
____________________
____________________
% used ____________ (-)
____________________
Adjusted Gross Income
(=)
____________________
Adjusted Tax
AGI Listed Above
x
Original Taxes Paid = Adjusted Tax
(=)
____________________
Original AGI
Other Untaxed Income Received: ie. Child support received
Type ______________________________
Amount ____________________
____________________________
__________________
Type
Amount
Parent’s Signature _____________________________________
Date
__________________________
This document can be made available in alternative formats by contacting
Disability Services at 218-733-7650 (voice) or 218-733-7705 (TTY).
Rev. 09/16

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