Student/Spouse Worksheet B

Question 41 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:

Tax Deferred Pension and Savings

Payments to tax-deferred pension and savings plans, paid directly or withheld from earnings. Include amounts in W2 boxes 12a through 12d, codes D, E, F, G, H, and S.

Amount:

Self-Employed Deductions

IRA deductions and payments to self-employed SEP, SIMPLE, and Keogh and other qualified plans from IRS Form 1040 - line 28 + line 32 or 1040A - line 17.

Amount:

Child Support

Child support received for all children. Don't include foster care or adoption payments:

Amount:

Tax Exempt Income

Tax exempt interest income from from IRS Form 1040 - line 8b or 1040A line - 8b.

Amount:

Foreign Income

Foreign income exclusion from IRS Form 2555 - line 45 or 2555EZ - line 18.

Amount:

Untaxed IRS Distributions

Untaxed portions or IRA distributions from IRS Form 1040 - lines (15a minus 15b) or 1040A - lines (11a mnus 11b). Exclude rollovers. If negative, enter a zero here.

Amount:

Pensions

Untaxed portions of pensions from IRS Form 1040 - lines (16a minus 16b) or 1040A - lines (12a minus 12b). Exclude rollovers. If negative, enter a zero here.

Amount:

Special Fuels

Credit for a federal tax on special fuels from IRS Form 4136 - line 20. Non-farmers only.

Amount:

Living Allowances

Housing, food and other living allowances paid to members of the military, clergy and others. Include cash payments and cash value of benefits.

Amount:

Veterans

Veterans noneducation benefits such as Disability, Death Pension, or Dependency Indemnity Compensation, and/or VA Educational Work Study allowances.

Amount:

Other Untaxed Income

Other untaxed income not reported elsewhere on Worksheets A and B, such as workers compensation, untaxed portions of railroad retirement benefits, Black Lung Benefits, disability, etc. Tax filers only: report combat pay not included in AGI (FAFSA questions 35 and 79). Don't include student aid, Workforce Investment Act educational benefits, combat pay if you are not a tax filer, or benefits from flexible spending arrangements (eg., cafeteria plans).

Amount:

Money Received

Money received, or paid on your behalf (eg bills), not reported elsewhere on this form.

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

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Fontbonne University

Student/Spouse Worksheet B

Question 41 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).