2021 – 2022 Parent Non-Tax Filer’s Statement
Office of Financial Aid
This form should be completed if one or both of your parents did not file a 2019 U.S. federal tax return. Student Name: _____________________________________________________________ Student ID#:_______________________
PARENT INFORMATION (PLEASE PRINT CLEARLY): Non-Tax Filing Parent completing this form: [ ] Mother/Step-Mother [ ] Father/Step-Father [ ] Both Parents Mother/Step-Mother’s Name: ___________________________ _________________________ Father/Step-Father’s Name: ________________________________________________
List all sources of income and dollar amounts received from January 1, 2019 to December 31, 2019. AMOUNT EARNED IN 2019 5,000
SOURCE OF INCOME (Such as: work, worker’s comp, SSI, child support, family or friends, etc.)
EXAMPLE: ABC Corporation
INDICATE MOTHER OR FATHER Mother
Provide a copy of W-2’s, 1099’s, etc. for each source of income listed above. BENEFITS RECEIVED IN 2019: • Public Assistance? • Social Security Insurance? • SNAP (Food Stamps)?
YES ___ ___ ___
NO ___ ___ ___
By signing this form, I certify that: ➢ I have attempted to obtain verification of non-filing from the IRS and was unable to obtain it. ➢ I have not filed and was not required to file a 2019 tax return. ➢ Confirm the above information is complete and correct. Mother/Step-Mother Signature ________ Father/Step-Father Signature ________
_____
Date Date
SUBMIT THIS FORM TO YOUR OFFICE OF FINANCIAL AID