2009-2010 Application for Financial Aid Freshman and Transfer Student
PRIORITY FILING DATE: April 1, 2009
Please complete all sections of this form including signatures. Incomplete forms will not be processed. I.
Student Information .................................................................................................................................................................................................................
Last Name
First Name
Middle Initial
Date of Birth
Social Security #
.................................................................................................................................................................................................................
City
Address
State
Zip code
.................................................................................................................................................................................................................
Home Telephone #
Citizenship:
Cell Phone #
● U.S. Citizen
Student E-mail Address
● Eligible Non-Citizen: Alien Registration #. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ● International Student
II. Enrollment and Housing Status Please check the appropriate boxes below; please do not leave blank. ● Full-Time (12-20 cr.)
Fall 2009 (Sept.-Dec.):
● 3/4 Time (9-11 cr.)
● 1/2 Time (6-8 cr.)
● Less than 1/2 Time (1-5 cr.)
● 3/4 Time (9-11 cr.)
● 1/2 Time (6-8 cr.)
● Less than 1/2 Time (1-5 cr.)
(Most students will be full-time)
Spring 2010 (Jan.-May):
● Full-Time (12-20 cr.) (Most students will be full-time)
In 2009-2010, year of program:
● 1st
● 2nd
● 3rd
When do you expect to graduate from college?
..........................................................
Month
Where will you be living?
● On-Campus
● 4th
Year
● With Parents/Relative
● Off-Campus
III. Outside Sources of Aid Report below all expected outside sources of financial assistance for the 2009-2010 academic year. ● Tuition Reimbursement from employer or parent’s employer:
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Name of Employer
● Veterans’ Benefits: $. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . per month, for Amount
Amount
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . months
during the 2009-2010 academic year.
# of Months
● Private scholarships from high school, church or other organizations: (Please provide the Scholarship Notification if available) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Name of Scholarship
Fall Amount
Spring Amount
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Name of Scholarship
Fall Amount
Spring Amount
If you are receiving more than two private scholarships, please attach an additional sheet. ● Any anticipated 529 or Uplan disbursements:. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Type of Plan
Amount
● Any other resources or benefits: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Name of Resource or Benefit
● Any anticipated state scholarships/grants:
Amount
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Name of Scholarship/Grant
State
Amount
IV. FAFSA Verification Information A. Family Size Please read carefully to determine who to include in your family size. DEPENDENT STUDENTS* (if you are required to provide your parents’ information on the FAFSA) list: • Your parent(s) (including stepparent) • Your sibling(s) if they receive more than 50% of their financial support from your parent(s). • Other people who live with and receive at least 50% of their financial support from your parents and will continue to receive this support through June 30, 2010. • Include the college name and enrollment status for any household member who will be attending college at least half time and enrolled in a degree/certificate program between July 1, 2009 and June 30, 2010.
List Name(s) included in your Family Size
Relationship
Name of College/University Attending in 2009-2010
If Attending College Check One:
If Attending College Check One:
Self
Emmanuel College
● Half-Time or greater ● Less Than Half-Time
● Undergraduate ● Graduate
2
● Half-Time or greater ● Less Than Half-Time
● Undergraduate ● Graduate
3
● Half-Time or greater ● Less Than Half-Time
● Undergraduate ● Graduate
4
● Half-Time or greater ● Less Than Half-Time
● Undergraduate ● Graduate
5
● Half-Time or greater ● Less Than Half-Time
● Undergraduate ● Graduate
6
● Half-Time or greater ● Less Than Half-Time
● Undergraduate ● Graduate
7
● Half-Time or greater ● Less Than Half-Time
● Undergraduate ● Graduate
8
● Half-Time or greater ● Less Than Half-Time
● Undergraduate ● Graduate
Age
1 You - student applicant
Note: Half-time is usually considered two courses per semester. If more than eight family members, use additional pages. *INDEPENDENT STUDENTS (if you are not required to provide your parents’ information on the FAFSA) please list your spouse, your children (only if they receive more than 50% of their financial support from you) and other people who live with and receive more than 50% of their financial support from you and will continue to through June 30, 2010.
B. 2008 Federal Income Tax Filing Status Student Filing Status – Check One:
Parent(s) Filing Status – Check One:
● I have filed a 2008 Federal Income Tax Return. A signed copy complete with schedules and W-2 forms is attached.
● I (we) have filed a 2008 Federal Income Tax Return. A signed copy complete with schedules and W-2 forms is attached.
● I will file a 2008 Federal Income Tax Return. A signed copy complete with schedules and W-2 forms will be mailed at a later date. ● I did not and am not required to file a 2008 Federal Income Tax Return. ● I have requested a Federal Income Tax Extension from the IRS. Attached is a copy of Form 4868 and copies of my 2008 W-2 forms, or, if self-employed, a signed statement certifying estimated adjusted gross income for 2008.
● I (we) will file a 2008 Federal Income Tax Return. A signed copy complete with schedules and W-2 forms will be mailed at a later date. ● I (we) did not and am not required to file a 2008 Federal Income Tax Return. ● I (we) have requested a Federal Income Tax Extension from the IRS. Attached is a copy of Form 4868 and copies of my 2008 W-2 forms, or, if self-employed, a signed statement certifying estimated adjusted gross income for 2008.
C. Sources of Untaxed Income Please list below sources of untaxed income that you were not required to report on your Federal Income Tax Return. NOTE: Only complete applications will be processed. Please enter an amount or a zero (0) in the spaces below.
Student/Spouse
2008 Annual Amount
Parent(s)
2008 Annual Amount
If not filing a tax return, enter your earned income (refer to your 2008 W-2 forms).
$. . . . . . . . . . . . . . . .
If not filing a tax return, enter earned income (refer to your 2008 W-2 forms).
$. . . . . . . . . . . . . . . .
Payments to tax deferred pension and savings plans (paid directly or withheld from earnings), including amounts reported on W-2 Form in Box 12a-12d, codes D, E, F, G, H and S.
$. . . . . . . . . . . . . . . .
Payments to tax deferred pension and savings plans (paid directly or withheld from earnings), including amounts reported on W-2 Form in Box 12a-12d, codes D, E, F, G, H and S.
$. . . . . . . . . . . . . . . .
Child Support received for all children. Do not include foster care or adoption payments.
$. . . . . . . . . . . . . . . .
Child Support and/or other monetary support received for all children. Do not include foster care or adoption payments.
$. . . . . . . . . . . . . . . .
Welfare Benefits, including Temporary Assistance for Needy Families. Do not include food stamps or subsidized housing.
$. . . . . . . . . . . . . . . .
Untaxed Social Security Benefits (such as SSI) paid directly to parent.
$. . . . . . . . . . . . . . . .
Welfare Benefits, including Temporary Assistance for Needy Families. Do not include food stamps or subsidized housing. Untaxed Social Security Benefits (such as SSI) paid directly to student.
$. . . . . . . . . . . . . . . . $. . . . . . . . . . . . . . . .
Housing, food, and other living allowances paid to members of the military, clergy, and others (including cash payments and cash value of benefits). $. . . . . . . . . . . . . . . . Veterans non-education benefits such as Disability, Death Pension, or Dependency & Indemnity Compensation (DIC), etc.
$. . . . . . . . . . . . . . . .
Other untaxed income not reported, such as workers’ compensation, disability, etc. Don’t include student aid, earned income credit, child tax credit, welfare payments, untaxed Social Security benefits, Workforce Investment Act educational benefits, combat pay (if you are not a tax filer), benefits from flexible spending arrangements (e.g., cafeteria plans), foreign income exclusion or credit for federal tax on special fuels. $. . . . . . . . . . . . . . . . Money received, or any money paid on your behalf, not reported elsewhere on this form. Total
$. . . . . . . . . . . . . . . .
Housing, food, and other living allowances paid to members of the military, clergy, and others (including cash payments and cash value of benefits). $. . . . . . . . . . . . . . . . Veterans non-education benefits such as Disability, Death Pension, or Dependency & Indemnity Compensation (DIC), etc.
$. . . . . . . . . . . . . . . .
Other untaxed income not reported, such as workers’ compensation, disability, etc. Don’t include student aid, earned income credit, child tax credit, welfare payments, untaxed Social Security benefits, Workforce Investment Act educational benefits, combat pay (if you are not a tax filer), benefits from flexible spending arrangements (e.g., cafeteria plans), foreign income exclusion or credit for federal tax on special fuels. $. . . . . . . . . . . . . . . . Money received, or any money paid on your behalf, not reported elsewhere on this form.
$. . . . . . . . . . . . . . . .
Total
$. . . . . . . . . . . . . . . . $. . . . . . . . . . . . . . . .
D. Title IV Income Exclusions Please enter an amount or a zero (0) in the spaces below. Annual Amount
Student/Spouse
Annual Amount
Parent(s)
Child support paid because of divorce or separation. Do not include support paid for children who are listed in the family size chart. $. . . . . . . . . . . . . . . .
Child support paid because of divorce or separation. Do not include support paid for children who are listed in the family size chart. $. . . . . . . . . . . . . . . .
Federal Work-Study earned in 2008.
$. . . . . . . . . . . . . . . .
Federal Work-Study earned in 2008.
$. . . . . . . . . . . . . . . .
$. . . . . . . . . . . . . . . .
Student grant, scholarship, and fellowship aid, including AmeriCorps awards, that was reported to the IRS in your adjusted gross income.
$. . . . . . . . . . . . . . . .
$. . . . . . . . . . . . . . . .
Combat pay or special combat pay. Only enter the amount that was taxable and included in your adjusted gross income.
$. . . . . . . . . . . . . . . .
Student grant, scholarship, and fellowship aid, including AmeriCorps awards, that was reported to the IRS in your adjusted gross income. Combat pay or special combat pay. Only enter the amount that was taxable and included in your adjusted gross income. Total
$. . . . . . . . . . . . . . . .
Total
$. . . . . . . . . . . . . . . .
E. Asset Information Please list the current market value and total liabilities/debts against each asset. Please enter either an amount or a zero (0) in the spaces below. Student/Spouse Value Debt Parent(s)
Value
Cash, Savings, Checking
$. . . . . . . . . . . . . . . .
Cash, Savings, Checking
$. . . . . . . . . . . . . . . .
Investments (stocks, bonds)
$. . . . . . . . . . . . . . . .
Investments (stocks, bonds)
$. . . . . . . . . . . . . . . .
Home (primary residence)
$. . . . . . . . . . . . . . . .
$. . . . . . . . . . . . . . . .
Home (primary residence)
$. . . . . . . . . . . . . . . .
$. . . . . . . . . . . . . . . .
Other Real Estate (rental property, vacation home, etc.) $. . . . . . . . . . . . . . . .
$. . . . . . . . . . . . . . . .
Other Real Estate (rental property, vacation home, etc.) $. . . . . . . . . . . . . . . .
$. . . . . . . . . . . . . . . .
Business/Farm
$. . . . . . . . . . . . . . . .
$. . . . . . . . . . . . . . . .
Business/Farm
$. . . . . . . . . . . . . . . .
$. . . . . . . . . . . . . . . .
● More than 100 full-time employees
● 100 or less full-time employees
● More than 100 full-time employees
● 100 or less full-time employees
Does this business have:
Does this business have:
Debt
V. Comments (optional) Provide below information regarding any special circumstances that might be helpful to us when assessing your financial need. Attach an additional sheet if necessary. ................................................................................................................................................................................................................. ................................................................................................................................................................................................................. ................................................................................................................................................................................................................. ................................................................................................................................................................................................................. .................................................................................................................................................................................................................
VI. Permission to Share Information/Certification of Accuracy I understand the Office of Student Financial Services at Emmanuel College may have to discuss my tax return or other personal information with my child/parent/spouse or other College officials to clarify his/her eligibility for financial aid. I attest that the information in this application and all submitted supporting documentation is true and complete to the best of my knowledge. I know that I am required to notify Emmanuel College if I receive other scholarships or grants not reported on my Financial Aid Award Letter and I understand that changes to my enrollment or housing status may affect my eligibility for financial assistance. I understand my financial aid is estimated until all requested documentation is submitted and the verification of application data is complete. NOTE: Only complete applications will be processed. Please review this application to ensure that either an amount or a “0” (zero) has been entered where designated. Both signatures are required. Student's Signature. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Date. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Parent's Signature. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Date. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
To apply for financial assistance at Emmanuel College, in addition to this application, please complete and submit the 2009-2010 FAFSA to the federal processor (this application is available in paper format or online at www.fafsa.ed.gov). The Emmanuel College Federal School Code is 002147.
Please return this application to:
Office of Student Financial Services 400 The Fenway Boston, MA 02115
Office of Student Financial Services
•
617-735-9938 phone
•
617-735-9939 fax
•
financialservices@emmanuel.edu