Military Information Form

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2016-17
FINANCIAL AID OFFICE
Military Information Form
This form is to verify non-taxable military allowances for an independent student (and/or their spouse), or for the parent of a
dependent student who is/was on active military duty from January 1, 2015 to December 30, 2015. Complete this form and
submit to the Financial Aid Office on the campus the student will be attending.
Note: If amounts reported seem unusually low, you may be required to submit additional verification of what was reported.
Please TYPE or PRINT legibly.
Student Name:
UH ID#:
Phone Number:
Date of Birth:
1. The following information applies to:
Applicant
Spouse
Father
Mother
2. Initial date of military service in Hawaiʻi: (month/year)
3. Pay grade:
4. Indicate the ANNUAL amount received for each of the following items below for the 12-month period of 1/1/2015–
12/31/2015. Respond to all items with a dollar amount or indicate a zero (0) where applicable. Do not leave any item blank.
* If you need assistance in obtaining the non-taxable income information, refer to the military member’s Leave Earnings
Statement (LES) or contact the Department of Defense Finance & Accounting Services at 1-888-332-7411.
2015 Calendar Year
NON-TAXABLE INCOME
(Annual Total)
$
a. Cost of Living Allowance (COLA)
$
b. Basic Allowance for Subsistence (BAS)
$
c. Clothing Maintenance Allowance (CMA)
$
d.
Other:
$
e. TOTAL NON-TAXABLE MILITARY ALLOWANCE INCOME
(the sum of lines 4a – 4d should be reported on line 45g or 94g on your FAFSA)
I (We) certify that the information provided is true and correct to the best of my (our) knowledge. I (We) understand that any
false statement or misrepresentation may be a cause for the denial, reduction, or repayment of the student’s aid.
Student signature:
Date:
Parent (if dependent) signature:
Date:
RETURN THIS FORM ALONG WITH ANY OTHER REQUIRED DOCUMENTATION TO THE COMMUNITY COLLEGE CAMPUS THAT YOU WILL BE ATTENDING:
Community College
Address
Email
Phone
Kapiʻolani Community College
4303 Diamond Head Road * Honolulu, HI 96816
kapinfo@hawaii.edu
(808) 734-9555
96-045 Ala ʻIke Street * Pearl City, HI 96782
Leeward Community College
lccfao@hawaii.edu
(808) 455-0606
45-720 Keaʻahala Road * Kāneʻohe, HI 96744
Windward Community College
wccfao@hawaii.edu
(808) 235-7449
UH HILO, UH WEST OAHU AND UH MĀNOA STUDENTS NEED TO CONTACT THEIR FINANCIAL AID OFFICE FOR CAMPUS SPECIFIC FORMS.
Rev. 12/2015

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