Aid For Part-Time Study (A.p.t.s.) Application (Page 4 of 4) in pdf

7-8. MARITAL STATUS. Check the box that applies to you. If you were married as of December 31st, you must

report income information for your spouse in question 11. Enter the month and year you were married or, if

separated/divorced or widowed, give earliest date on which you were separated/divorced or widowed. If you are

other than SINGLE, enter your spouse's Social Security Number in item 15. (NOTE: Any separation must be by

judicial decree or pursuant to an agreement which is filed by a court of competent jurisdiction.)

CHECK "YES" if you have graduated or will graduate from high school or if you received or will receive a

General Education Development (GED) certificate. You may also check "Yes" if you received a passing score on

a federally approved examination which demonstrates your ability to benefit from the education being offered.

Otherwise, check "No."

10. EMPLOYER REIMBURSEMENT. Awards under this program are limited by the actual tuition paid by the student.

In considering a student for an award, the institution must take into account other sources of financial aid

available.

Check YES If your employer has paid, or will reimburse, all or part of your tuition for the term(s) for which this

application for APTS is made, and enter amount of reimbursement, if known.

Otherwise, check NO.

11.

Enter your Net Taxable Income (NTI) in the boxes provided. Contact your Financial Aid Office if you have any

questions.

WERE YOU CLAIMED AS A TAX DEPENDENT?

12.

Check YES and report your parents' income on page 2 of the application if you were claimed as a

dependent on your parent's tax return.

Check NO and sign the affirmation on page 2 of the application if you were not eligible to be claimed as a

dependent by your parents. (If married, your spouse must also sign the application.) If you have checked

NO but have dependents of your own other than your spouse, also check the second box as indicated.

NOTE: If you were not claimed as a tax dependent on your parent's tax return, you must still report your

parents' income in question 14 if you could have been claimed but were not. The criteria for

determining whether or not you could have been claimed are detailed in the instruction booklet for

filing state and federal tax returns. Generally, you were eligible to be claimed as a dependent if:

you were single, and

your parent or parents provided more than one-half of your support in the previous year, and

your gross income was less than $2,900. If your income was more than $2,900, you could still

have been claimed if you were under 19 years of age or you were under 24 years of age and a

full-time student.

13. EXCLUSION OF PARENTS' INCOME. Report in question 14 the income of the parent with whom you lived most

last year or who had custody or would have had custody if you were a minor.

The income of a parent can be excluded in the cases of death, divorce or separation which occurred before

December 31st. You should check the appropriate box in question 13 and enter the date and amount of support

received on your behalf. (NOTE: Any separation must be by judicial decree or pursuant to an agreement of

separation which is filed by a court of competent jurisdiction.)

14. PARENTS' INCOME. The instructions for reporting income information are the same as appear in question 11.

Report the following incomes: father's (stepfather's, adoptive father's) income and mother's (stepmother's,

adoptive mother's) income. If you excluded the income of one parent in question 13, report the income of the

other parent in question 14. In addition, enter Social Security Numbers as appropriate in the AFFIRMATION

Section.

15. AFFIRMATION. You MUST sign the application. In addition, if you are married, your spouse must sign and give

his/her Social Security Number. If your parents were required to provide income information in question 14, they

must sign and give their Social Security Numbers and the first three letters of their last name.

In signing this AFFIRMATION you are acknowledging that you have read, understood and accepted the

conditions described in the AFFIRMATION appearing on the application form.

DISCLOSURE OF SOCIAL SECURITY NUMBERS

Disclosure of your Social Security Number and the Social Security Numbers of members of your family is mandatory

and has been authorized by NYS Education Law º 661 subdivision (2).

We need these numbers to verify your identity, to process your application, to keep track of your records and to verify

reported incomes from the New York State Department of Taxation and Finance.

NO DISCRIMINATION ON THE BASIS OF DISABILITY

We do not discriminate against handicapped persons in our employment practices or in the administration of our

programs, activities or services.

H8083B (Rev. 02/2003)

Aid For Part-Time Study (A.p.t.s.) Application Page 4

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