2015 Income Estimate Due To Loss Or Change Of Job Form (Page 2 of 2) in pdf

2015 Income Estimate Due To Loss Or Change Of Job Form Page 2

Year to Date

Estimated Income

Total Income for Year

2015 Untaxed Income

Voluntary contributions to retirement

plans such as 401(K) or 403(B) plans and

savings plans

(paid directly or withheld from earnings)

IRA, Keogh and/or SIMPLE payment

Untaxed portion of pension distributions

or withdrawals (excluding “rollovers”)

2015 Additional Information

Please use this section to provide additional information concerning your situation, if the above sections did not

allow you to explain the circumstances fully. Attach additional pages and documentation as necessary.

_________________________________________________________________________________________________________________________

Certification

By signing below, I

1. affirm that the data contained on this form is true and complete to the best of my knowledge,

2. acknowledge that submission of information does not guarantee an adjustment to the student’s award

3. understand that I am responsible for immediately notifying SFS if this information changes, and that future

financial aid awards may be reduced if income estimates are underestimated on this form.

Student: _______________________________________________________________________________________ Date: ___________________________

Parent: ________________________________________________________________________________________ Date: ___________________________

Please return completed form and supporting documentation to:

Bates College

Student Financial Services

Bates College

44 Mountain Avenue

Lewiston, ME 04240

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2015 Income Estimate Due To Loss Or Change Of Job Form Page 2