Student/Spouse Worksheet A

Question 40 on your FAFSA was left blank. Please complete and submit this form as part of the financial aid application process. If the question does not apply, please enter "N/A" (Not Applicable).

Student Information

First Name:
Last Name:
Last 4 Digits of Social Security Number:
Student ID Number:

Earned Income Credit

Earned income credit from IRS Form 1040 - line 66a; 1040A - line 40a; or 1040EZ - line 8a.

Amount:

Additional Child Tax Credit

Additional child tax credit from IRS Form 1040 -line 68 OR 1040A - line 41:

Amount:

Welfare Benefits

Welfare benefits, including Temporary Assistance for Needy Families (TANF). Don't include food stamps or subsidized housing

Amount:

Social Security Benefits

Social Security benefits received for all household members as reported in question 90 that were not taxed.

Amount:

Enter Total Amount Here

Add all of the amounts together

Total:

Electronic signature

By submitting this online document, you certify that the information on this form is true and correct. You further understand that if you purposely give false or misleading information on this form in order to obtain financial assistance, that your financial aid will be cancelled and that you may be subject to fines, imprisonment, or both.

Please Select One:

I Disagree

I Agree

Some required answers are missing or incorrect.

Fontbonne University

Student/Spouse Worksheet A

Question 40 on your FAFSA was left blank. Please complete and submit this form as part of the financial aid application process. If the question does not apply, please enter "N/A" (Not Applicable).