Cover Sheet And Tax I.d. / Non-Tax Filer Form

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Cover Sheet and
Student Financial Services
Tax I.D. / Non-Tax Filer Form
University of Pennsylvania
005 Franklin Building
3451 Walnut Street
Philadelphia, PA 19104-6270
Academic Year 2016-2017
Fax: (215) 573-5428
Use a Cover Sheet each time you submit documents
DO NOT submit duplicate documents
Submit online at:
https:// /forms/OnlineDocSubmitForm.php
OR
Fax to 215-573-5428 (documents are received electronically)
Be sure to fax both sides of 2-sided documents
Student Information
Check one:
Applicant
Undergraduate (Penn) Student
Graduate/Professional (Penn) Student
Penn I.D. or Social Security Number
Email
Last Name
First
Initial
Birthdate
Parent Information
Mother’s Full Name
Custodial
Noncustodial
Father’s Full Name
Custodial
Noncustodial
Please note the documents you are submitting with this cover sheet below: Number of pages:
Non-Tax Filers
(if you or your parents will not file taxes for 2015 you are required to complete this section)
I, the student, certify that I did not file and am not required to file an income tax return for 2015.
I/we, the parent(s), certify that I/we did not file and am/are not required to file an income tax return for 2015.
Certification and Signature
I/we certify that the information provided on all financial aid applications is true, complete, and correct to the best of my knowledge.
Student signature________________________________________________________________________Date__________
Parent signature_________________________________________________________________________Date__________

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