EOP FINANCIAL AND FAMILY QUESTIONNAIRE

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1 STATE UNIVERSITY OF NEW YORK EOP FINANCIAL AND FAMILY QUESTIONNAIRE Before any final decision can be made on your admission application to the, you are required to submit household information and income documentation so that your economic eligibility for EOP can be determined. Economic Eligibility: 1. Financial Eligibility Form You must complete the financial eligibility form (freshmen only) FEDERAL INCOME TAX RETURN - Submit a signed copy of your/your parent s Federal Income Tax Return (IRS 1040/1040A/1040EZ). Include all schedules and W2 forms. 3. NON-TAXABLE INCOME Submit documentation of all non-taxable income received in 2013, such as Social Security, Social Services, and Veterans Benefits. Ask your case worker or an authorized official to complete,sign and stamp Form C and/or Form D, if applicable. 4. You must file the FREE APPLICATION FOR FEDERAL STUDENT AID (FAFSA) and indicate New Paltz, college code #002846, as a school to receive your information. Remember, no final or official admission decision or financial aid will be offered without the materials listed above. PLEASE PRINT (DO NOT LEAVE ITEMS BLANK) Student s Name: Last Name First Name M.I. Permanent Address: Street Apt. # City State Zip Code Social Security Number: Phone Number: (Day) (Evening) Date of Birth: Date you began living in New York State: Date of High School graduation or G.E.D. Month/ Day /Year Month/ Day /Year Month/ Day /Year Name of High School: Name of Guidance Counselor / College Advisor: Are you a veteran? yes no Have you ever attended another college? yes no 1

2 If yes, name of college: Date of attendance: Are you a citizen of the United States? yes no If no, enter Alien Registration Number: Attach a photocopy of your Resident Alien Card (both sides). Are you a ward of the state? yes no If yes, complete Section A and skip Section B. Sign the certification on page 4, and return form. (Attach documentation that you are a ward of state; i.e., court papers, letter from Social Services Agency.) If you are not a ward of state and do not live with your parents, see the special instructions on the bottom of this page. SECTION A: Student Information Check a or b: a. Student did or will file a 2013 income tax return. (Attach a photocopy of student s 2013 Federal Tax Return, including all schedules and W-2 forms.) b. Student will NOT file a 2013 income tax return Source of income: Do not leave any blanks. If answer is 0 put in a $0. Earnings from Work: Interest Income: Trust Fund/ Inheritance: Other: Student Assets: Report information as of the day you are completing this form. Cash Checking Account: Savings: Investments: Other: SPECIAL INSTRUCTIONS FOR STUDENTS WHO DO NOT LIVE WITH THEIR PARENTS: If you are not a ward of the state and do not live with your parents, you must attach documentation as to why it is necessary for you to live with someone other than your parents. Documentation can be any legal documents regarding custody or a letter from a social worker, attorney, or high school guidance counselor. Please note that even if you do not live with either parent you may still be required to provide their income information for Financial Aid purposes. It is advised that you collect their tax returns and submit them if at all possible. -Please DO NOT leave items blank- 2

3 SECTION B: Parent Information *For questions on who is considered a parent, view the FAFSA website at: Check a or b: a. Parents did or will file a 2013 income tax return. Attach a photocopy of the signed 2013 Federal tax return, including all schedules and W-2 forms. b. Parents will NOT file a 2013 income tax return. Income: Tax filers and non-taxfilers must answer the following for the year Do not leave blank. If answer is 0, put in a $0. Submit documentation for ALL income received in 2013 Father s earnings: Mother s earnings: Social Security: Complete form C, if social security is received Social Services: Complete form D, if social services benefits are received Interest income: Dividends: Child Support: Include money received for all children in household. Trust Funds/Inheritance: Other: Assets: Taxfilers and non-taxfilers must answer asset questions. Report information as of the day you are completing this form. Cash, checking accounts: Savings: Investments: Parents monthly: _ rent paid or mortgage payments Do parents own a home? yes no If yes, year of purchase: Purchase price: Do parents own other real estate? yes no If yes, market value? _ Debt: Do parents own a business? yes no If yes, What type of business? Value of the business: Debt on the business: -Please DO NOT leave items blank- 3

4 SECTION C: Household Information PLEASE DO NOT LEAVE ANY QUESTIONS BLANK IN THIS SECTION. 1. The current marital status of the parent you live with is: married to biological parent married to step-parent Year remarried divorced/separated from biological parent Year of divorce divorced/separated from step-parent Year of separation widowed from biological parent Year parent widowed never married* *If you checked never married, what is the last date your parents lived in the same household? * Please give information about both biological parents UNLESS the parent you live with has remarried. In that case, give information for that parent and step-parent. A. Father s Name: Father Stepfather Legal Guardian Address: Occupation: Employer: B. Mother s Name: Mother Stepmother Legal Guardian Address: Occupation: Employer: Is there an agreement between natural parents specifying a contribution for the student s education? yes no 2. Give information for ALL FAMILY MEMBERS who reside in your household: FULL NAME AGE RELATIONSHIP COLLEGE NAME (IF ATTENDING) Before signing the certification, review your application. Do not leave any blanks. Make sure all required documents are attached. File will NOT be reviewed until all supporting documentation is received. CERTIFICATION: I swear that all information reported on this form is correct. I understand that any deliberate falsification or omission of information may result in denial of admission, dismissal from the college or legal action. Student s Signature Parent s Signature Date Date Please return this form to: SUNY New Paltz 1 Hawk Drive, New Paltz, New York

5 STATE UNIVERSITY OF NEW YORK Form C SOCIAL SECURITY VERIFICATION Submit ONLY IF benefits were received in 2013 Financial Aid Applicant: Your Federal Financial Aid application requires you to provide verification of your Social Security benefits. Please submit form 1099 for 2013 for all household members receiving benefits or complete the following form: 1. Complete Sections I, II, and III. 2. Take this form to your Social Security Office - they will complete the section marked For Social Security Use Only on the back of this form. 3. When completed, return this form to the at the State University of New York at New Paltz. SECTION I Student s Name Last First Social Security Number Address Street Apt. City State Zip SECTION II: Release of information If you were a dependent student during 2013, this release statement must be signed by you and your parent (s). If you were an independent student during 2013, this release statement must be signed by you (and your spouse, if you are married). I give the Social Security Administration the authority to disclose to SUNY New Paltz the amount of 2013 Social Security benefits paid for myself and my minor children as listed in Section III following. Student s Signature Spouse s Signature Mother s Signature Father s Signature Social Security Number Social Security Number Social Security Number (over)

6 SECTION III Please list parents, student, and all family members under age 19. For Social Security Use only: Total amount paid during 2013 for each person listed Signature and Title of Authorized Social Security Official Agency Stamp Address of District Office Telephone Number Date Your Financial Aid cannot be processed until this form (if applicable) and any other requested documentation is completed and returned to: SUNY New Paltz 1 Hawk Drive New Paltz, New York

7 STATE UNIVERSITY OF NEW YORK Form D SOCIAL SERVICES VERIFICATION Submit ONLY IF benefits were received in 2013 CASE NUMBER TO: Social Services Department The following student: Student Social Security Number: Case Name: Address: Street Apt. Social Security for case name City State Zip Code... is applying for financial aid at New Paltz and has indicated that his/her family received Social Services assistance during We would appreciate your help in establishing financial need according to the applicant s income and assets by providing the following information for that year: 1. Type of Assistance: 2. Amount of Assistance: OR (monthly) (yearly) 3. How many members are there in the household? 4. Please indicate any other sources of income this household may be receiving: Thank you for your cooperation. If you have any questions, please call the Financial Aid Office at (845) (Date) PLEASE RETURN TO: SUNY New Paltz 1 Hawk Drive New Paltz, New York (Signature of Caseworker) (Agency Stamp)

8 STATE UNIVERSITY OF NEW YORK Office of Financial Aid What type of financial aid is available to accepted EOP Freshmen? Sample New Paltz EOP Freshman financial aid package * SUNY New Paltz is committed to offering EOP Freshmen a first-year financial aid package that provides grant aid to cover the majority of a student s billed expenses. Below is an estimated sample of the financial aid package for year s billed expenses Tuition...$5,870. Fees **...$1,213. Room....$6,880. Meal Plan....$3,640. TOTAL... $17,603. year s aid PELL Grant....$5,6450. TAP Grant...$5,000. SUNY Tuition Credit....$895. EOP Grant....$1,905. Other Grants....$700. TOTAL Grant Aid... $14,145. Subsidized Loan...$3,500. TOTAL AID... $17,645. Optional Financial Aid (for books, transportation and personal expenses) Federal College Work Study....$1, Unsubsidized Loan....$2, * The largest share of available grant aid is issued to EOP students in their first year of college. In their following years of college, most EOP students will receive grants to cover approximately 70% of billed expenses with the remainder covered by Direct Subsidized and Direct Unsubsidized Loans. ** Conditional Health Insurance Fee $1,691 (Health insurance fee is optional if you are already covered under a family health insurance plan.) DISCLAIMER: Cost and Aid are subject to change at any time due to changes in state and federal regulations. Office of Financial Aid SUNY New Paltz 200 Hawk Drive New Paltz, New York fax

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