TRIO SES & STEM APPLICATION – Addendum

PARENT/GUARDIAN INCOME VERIFICATION FORM

Instructions: Fill in this this form if you are a dependent student and you did not file the FAFSA or did not submit a signed income tax return with your TRIO Application.

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Please review the marked fields below.

Student Information

Last Name

First name

Middle Initial

Student ID

Income Status

Are you a dependent or independent student? (If independent, student does not need to submit this form)

Dependent or Independent Student

Dependent: You are considered a dependent student if you do not meet any of the criteria for independent status.
Independent:You are considered Independent if you meet at least one of the following criteria:
- At least 24 years old by Dec. 31.
- Orphan or ward of court at 18 years old.
- Married.
- Veteran or active duty military.
- Have legal dependents.
- Homeless as a minor.

Select one:

Dependent

Independent

Income Verification

Please use my signed FAFSA data on file with the University of Kansas.You do not need to submit this form.

I am attaching a signed copy of my parent/guardian’s income tax return for the most recent tax year. If you are independent please attach your income tax return for the most recent tax year. You do not need to submit this form.

My parent/guardian or I respectfully decline to provide a copy of our tax return but will report taxable income as listed on the income tax return for the most recent tax year. Parent/guardian please sign this form.

My parent/guardian or I did not submit an income tax return for the most recent tax year but attest that the total income from all sources from the most recent tax year. Parent/guardian please sign this form.

Total Income

Enter amount from 1040-line 43; 1040A-line 27; or 1040EZ-line 6.

Parent/Guardian Signature & Date

Parent/Guardian Signature

Date