Verification Of Parents' Income - 2016-2017 printable pdf download

NORTHWESTERN UNIVERSITY

Office of Financial Aid--Chicago

710 N. Lake Shore Drive, Room 629

Chicago, Illinois 60611-3078

STUDENT NAME:

(Please Print)

Student ID #______________________

DEGREE PROGRAM: ___________________________

2016-17 Verification of Parents’ Income

Please select the item below that best corresponds to you and respond as appropriate: (check ONLY one)

1. A 2015 U.S. income tax return has been or will be filed by the student’s parent(s).

(Please attach a signed copy of the complete tax return, W-2 forms, and all schedules to this form if you checked this

item. The student’s name and student ID number should be printed at the top of the first page of the return. If the

parent(s)’ tax return is not yet completed, check here [ ] submit your 2014 return and submit your 2015 tax return

separately as soon as it is completed.)

2. A 2015 U.S. income tax return was not filed by the student’s parent(s). However, a 2015 foreign income

tax form was filed.

(Please attach a signed copy of the complete foreign tax return to this form if you checked this item. Also, please provide

a signed statement that shows the conversion rate of foreign currency to U.S. dollars on the date the 2016-17 Free

Application for Federal Student Aid [FAFSA]/Renewal FAFSA was completed. The student’s name and student ID

should appear on all forms submitted).

3. A 2015 U.S. income tax return was not filed by the student’s parent(s) and the student’s parent(s) is (are)

not required to file a 2015 U.S. income tax return.

(Please report the income under each of the following categories if you checked this item; include stepparent data if

natural parent is remarried. Report zero '0' for a given category if appropriate--DO NOT LEAVE ANY ITEM BLANK.)

Father’s/Stepfather’s income from work during 2015

$____________________

Mother’s/Stepmother’s income from work during 2015

$____________________

Unemployment compensation received during 2015

$____________________

Social Security benefits received during 2015

$____________________

Child support received during 2015

$____________________

Welfare benefits (e.g., AFDC/ADC) received during 2015

$____________________

Pension benefits received during 2015

$____________________

Interest/dividend income earned during 2015

$____________________

Capital gains earned during 2015

$____________________

Foreign income excluded during 2015

$____________________

Other income (specify type): __________________________________

$____________________

TOTAL:

$____________________

PARENT(S)’ CERTIFICATION AND SIGNATURE(S):

I (We) certify that the information on this form and on the attached tax documents is true and complete.

Father/Stepfather:

__________________________________________________ DATE: ______________________

Mother/Stepmother:

__________________________________________________ DATE: ______________________

Please return this form and your 2015 U.S. income tax return (if applicable) to the Office of Financial Aid--Chicago at the address given

above. Call (312) 503-8722 if you have any questions regarding the completion of this form. Thank you for your cooperation.

Verification Of Parents' Income - 2016-2017

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