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2012-2013 Application for Financial Aid Freshman and Transfer Student

PRIORITY FILING DATE February 15, 2012

To apply for need-based financial aid at Emmanuel College, please complete: • All sections of this form, including signatures. Incomplete forms will not be processed. • The 2012-2013 FAFSA (www.fafsa.gov). We strongly encourage you and your parents to use the IRS Data Retrieval tool provided on the FAFSA. The Emmanuel College Federal School Code is 002147.

I. Student Information Last Name

First Name

Middle Initial

Date of Birth

Social Security Number

Address City State Zip Code

Home Phone Number Cell Phone Number E-mail Address

Citizenship:

U.S. Citizen

Eligible Non-Citizen: Alien Registration #

International Student

In 2012-2013, year in college: Housing Status:

1st

On-Campus

2nd

3rd

4th

With Parents/Relative

Off-Campus

II. Sources of Outside Aid Report all expected outside sources of financial assistance for the 2012-2013 academic year. Do not list scholarships awarded by Emmanuel College.

Source of Outside Aid

Amount $

Anticipated 529 or U.Plan Disbursements Name of Plan

Anticipated State Scholarships/Grants

$ Name of State Scholarships/Grants

Private Scholarships

Please provide scholarship notification, if available.

1) Private Scholarship

Fall Amount

Spring Amount

Attach an additional sheet, if receiving more than three private scholarships.

2) Private Scholarship

Fall Amount

Spring Amount

Fall Amount

Spring Amount

3) Private Scholarship

Tuition Reimbursement

(from student’s or parent’s employer)

$ Employer

Veterans’ Benefits

per month for months # of months during

Amount

Type of Benefit

2012-2013

Other Sources or Benefits

$ Source of Benefit

Office of Student Financial Services

•

617 735-9938 phone

•

617 735-9939 fax

•

financialservices@emmanuel.edu

III. FAFSA Verification Information A. Family Size If you are a dependent student required to provide parents’ information on the FAFSA, please list:

• Yourself

•

Your custodial parent(s), including stepparent (even if you do not live with your parents)

•

Your parents’ other children (if your parents will provide more than 50% of their financial

support between July 1, 2012 and June 30, 2013). •

Other people who live with and receive more than 50% of their financial support from your

parents and will continue to receive this support between July 1, 2012 and June 30, 2013. If you are an independent student not required to provide parents’ information on the FAFSA, please list:

•

Yourself (and your spouse)

•

Your children (if they receive more than 50% of their financial support from you and will continue to

receive this support between July 1, 2012 and June 30, 2013). •

Other people who live with and receive more than 50% of their financial support from you

and will continue to receive this support between July 1, 2012 and June 30, 2013.

Name

Relationship

Age

2012-2013 College Enrollment Half-time or greater at Emmanuel College

1. You

Self

Less than half-time at Emmanuel College

Half-time or greater at

Parent

Less than half-time at

Will not be attending college

Half-time or greater at

Less than half-time at

Half-time or greater at

Less than half-time at

Name of College/University

Will not be attending college

Half-time or greater at

Name of College/University

Less than half-time at

Name of College/University

Will not be attending college

Half-time or greater at

Name of College/University

Will not be attending college

Name of College/University

Less than half-time at

Will not be attending college

Name of College/University

Note: Half-time is usually considered two courses per semester. If you have more than six family members, please attach an additional sheet.

B. 2011 Federal Income Tax Filing Status Note: When completing or updating the FAFSA, we strongly encourage you and your parents to use the IRS Data Retrieval tool provided on the FAFSA. If not, you may need to request 2011 tax transcripts from the IRS.

Student/Spouse Check One:

2011 Federal Income Tax Filing Status

Parent(s) Check One:

I have filed a 2011 federal income tax return. I will file a 2011 federal income tax return. I requested a Federal Income Tax Extension from the IRS. Attached is a copy of Form 4868 and copies of my 2011 W-2 forms or, if self-employed, a signed statement certifying estimated adjusted gross income for 2011. I did not and am not required to file a 2011 Federal Income Tax Return.

C. 2011 Sources of Untaxed Income Student/Spouse Sources of Untaxed Income 2011 Annual Income

Parent(s) 2011 Annual Income

If not filing a tax report, enter your earned income (refer to W-2 forms).

Do not leave blank

Payments to tax-deferred pension and savings plans (paid directly or withheld from earnings), including, but not limited to, amounts reported on the W-2 form in Boxes 12a through 12d, codes D, E, F, G, H and S. Child support received and/or other monetary support received for all children. Do not include foster care or adoption payments.

Please list sources of untaxed income that you were not required to report on your Federal Income Tax Return.

Do not leave blank

Total (Do not include free or reduced price lunch.)

Do not leave blank

Student’s Source of Income

Parent’s Source of Income

Do not leave blank

Untaxed Social Security Benefits, such as Supplemental Security Income (SSI) $ Food Stamps - Supplemental Nutritional Assistance Program (SNAP) Total (Do not include Free or Reduced Price Lunch free or reduced price lunch.) Temporary Assistance for Needy Families (TANF) Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)

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) and/or VA Educational work-study allowances.

Other untaxed income not reported on this form, such as workers’ compensation, disability, the first-time home buyer tax credit, etc. Don’t include student aid, earned income credit, additional child tax credit, Workforce Investment Act educational benefits, on-base military housing or a military housing allowance, combat pay, benefits from flexible spending arrangements, foreign income exclusion or credit for federal tax on special fuels.

Money received, or paid on your behalf, not reported on this form.

Do not leave blank

D. 2011 Additional Financial Information Student/Spouse 2011 Annual Income $

Do not leave blank

Parent(s) 2011 Annual Income Child support paid to for (name of child/children for whom child support was paid).

2011 Federal Work-Study earnings and/or earnings from work under a cooperative education program offered by a college.

Taxable 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. Do not include untaxed combat pay.

Office of Student Financial Services

•

617 735-9938 phone

•

617 735-9939 fax

•

Do not leave blank

financialservices@emmanuel.edu

E. Asset Information Student/Spouse Value

Debt

Do not leave blank

$ Do not leave blank

Do not leave blank

Investments (stocks, bonds, CDs. Do not include retirement accounts)

Home (primary residence)

Do not leave blank

Value

Other Real Estate (rental property, vacation home, etc.)

Do not leave blank

Business/Farm: Does your business employ more than 100 fullDo not leave blank time employees? Yes No

Debt

Cash, Savings, Checking

Parent(s)

Asset Information

Do not leave blank

$ Do not leave blank

Do not leave blank

$ Do not leave blank

Do not leave blank

$ Do not leave blank

Do not leave blank

IV. Comments (optional) Please check off if attaching an additional sheet providing information regarding special circumstances that might be helpful when assessing your financial need.

V. 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.

Please print, sign and submit to the Office of Student Financial Services.

Student’s Signature Date Parent’s Signature Date Parent’s Cell Phone Parent’s Work Phone Parent’s E-mail

Please return this signed application to:

Application Checklist

Office of Student Financial Services

400 The Fenway

Please review this application to ensure: All sections have been completed, that either an amount or a “0” (zero) has been entered where designated.

Boston, MA 02115

fax to (617) 735-9939

e-mail at financialservices@emmanuel.edu

NOTE: Only complete applications will be processed.

Parent and student signed the application.