2014 Tax Return Extension Form - Student

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FR/SUM
2014 Tax Return Extension - S
TUDENT
A
Y
2015-2016
CADEMIC
EAR
Student Name: ______________________________________________________________________________
Student ID # (if applicable): _______________________
Last Four Digits of SSN: XXX - XX -___________
I certify the information provided on this form and any attachments is true and complete to the best of my
knowledge.
Student Signature: _______________________________________________
Date: ____________________
To confirm your 2015-2016 financial aid eligibility, our office requires additional information about your 2014 tax return extension.
Please complete ONLY ONE SECTION that is applicable to them below and submit this form along with the required
documentation to our office. Incomplete forms will not be processed. Please note: you may be asked to submit additional information
if needed.
Section I: You (and spouse) are NOT Self-Employed
Documentation Required
Check here if you (and your spouse) are NOT self-employed and have filed a
 Attach the 2014 Form 4868
2014 Tax Extension Form. Next, only complete the rest of Section I.
Your earnings from work: $_____________________________
 Attach the 2014 W2 Form(s)
Your spouse’s earnings from work: $_____________________________
 Attach the 2014 W2 Form(s)
Section II: You (and spouse) are ONLY Self-Employed
Documentation Required
Check here if
(and your spouse) are ONLY self-employed and have filed
you
 Attach the 2014 Form 4868
a 2014 Tax Extension Form. Next, only complete the rest of Section II.
Total 2014 Estimated Adjusted Gross Income: $_________________________________________
Total 2014 Estimated US Income Taxes Paid: $__________________________________________
Section III: You (and spouse) have earnings from W2 form(s) AND
Documentation Required
self-employment
Check here if you (and your spouse) have earnings from W2 form(s) AND
from self-employment and have filed a 2014 Tax Extension Form. Next, only
 Attach the 2014 Tax Form 4868
complete the rest of Section III.
Your earnings from work (W2): $_____________________________
 Attach the 2014 W2 Form(s)
Your NET earnings from self-employment: $________________________
 None
Your spouse’s earnings from work (W2): $_____________________________
 Attach the 2014 W2 Form(s)
Your spouse’s NET earnings from self-employment: $________________________
 None
Total 2014 Estimated Adjusted Gross Income: $_________________________________________
Total 2014 Estimated US Income Taxes Paid: $__________________________________________
For Office Use Only:
Logged in: _____________
Process Date: ____________
Counselor Initials: ___________
Decision (Approve/Deny): _________________
Update INAS (do NOT update tax return review date.)
Comments: ______________________________________________________________________________________________________________________________________________
18115 Campus Way NE, Box 358500 Bothell, WA 98011-8246 ● Phone: (425) 352-5240 ● Fax: (425) 352-3217
Office Hours: Monday – Friday 8:00 am to 5:00 pm ● Website:
● Email:
uwbfaid@uw.edu
MAR/2015

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