Federal Student Aid Programs - Indiana University South Bend Page 2
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2C. Student’s Tax Forms and Income Information (all applicants)
Dependent
1. Check only one box below. Tax returns include the 2010 IRS Form 1040, 1040A, 1040EZ, a tax return from Puerto
Rico or a foreign income tax return. If you did not keep a copy of your tax return, request a copy from your tax preparer
or request an Internal Revenue Service form that lists tax account information.
Check here if you used the IRS Data Retrieval process (recommended) and did not make any changes (only W2’s are required)
Check here if you are attaching a signed copy of your tax return.
Check here if a signed tax return will be submitted to the school by ______________________(date).
Tax Return.
2. Funds received for child support and other untaxed income. If none, enter zero.
(See Question 44 of the Free Application for Federal Student Aid (FAFSA).)
Sources of Untaxed Income
2010 Amount
Sources of Untaxed Income
2010 Amount
$
$
d.
a. Child Support
$
e.
$
b. Workman’s Compensation
$
f.
$
c. Untaxed Pensions
3.
income received in 2010 (use the W-2 form or other earnings statements if available).
Sources
2010 Income
$
$
$
D. Parent(s)’ Tax Forms and Income Information
1. Check only one box below. Tax returns include the 2010 IRS Form 1040, 1040A, 1040EZ, a tax return from Puerto Rico or a
foreign income tax return. If your parent(s) did not keep a copy of their tax return, request a copy from the tax preparer or request
an Internal Revenue Service form that lists tax account information.
Check here if your parent used the IRS Data Retrieval process (recommended) and did not make any changes (only W2s required)
Check here if you are attaching a signed copy of your parents’ tax return(s).
Check here if a signed tax return(s) will be submitted to the school by ______________________(date).
Tax Return.
2. Funds received for child support and other untaxed income. If none, enter zero. (See Question 92 of the FAFSA.)
Sources of Untaxed Income
2010 Amount
Sources of Untaxed Income
2010 Amount
$
$
a. Child Support
d.
b. Workman’s Compensation
$
e.
$
c. Untaxed Pensions
$
$
f.
3.
employer(s) and any income they received in 2010 (use the W-2 form or other earnings statements if available).
Sources
2010 Income
$
$
$
E. Sign this Worksheet
WARNING: If you purposely give false or misleading
on it is complete and correct. The student and at least one parent must
sign and date.
sentenced to jail, or both.
Student
Date
Parent
Date
Do not mail this worksheet to the Department of Education. Submit this worksheet to your Finan-
cial Aid Administrator at your school. Don’t forget to sign your tax forms.
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