Professional Documents
Culture Documents
Office of Financial Aid and Scholarships 102 Aldrich Hall Irvine, CA 92697-2825 (949) 824-8262 www.ofas.uci.edu (949) 824-4876 (fax)
*73392716EVSIGN,,11*
SIU, JANET LEE - 73392716 U C
You MUST print, sign and submit this form with the following documentation: a SIGNED copy of pages one and two of parent(s)' federal tax return with Schedule E, if applicable. (Only page one required for 1040EZ.) We do not accept IRS electronic signatures.
By signing this worksheet, we certify that all the information reported to qualify for federal student aid is complete and correct. We also certify that we understand that the Office of Financial aid may request additional information to verify information reported on this form.
X
Signature Date
X
Parent's Name (print): Last First Middle Signature Date Household Size & Family Members in College Relationship to the student Born on or after January 1, 1988? For family members born on or after January 1, 1988 who will enroll at least 1/2 time in College in 2011-2012 Name of College
Full Name
Y N N N N
Degree pursuing
SIU, JANET LEE Karen Siu Annie Siu Trinh Ly Donald Siu
UC Irvine
BS, BA
Confirmation #59328-8416
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Supplemental Information/Programs
Yes No No Yes No No
Dislocated Worker Supplemental Security Income Food Stamps Free or Reduced Price School Lunch Temporary Assistance for Needy Families (TANF) Special Supplemental Nutrition Program for Women, Infants & Children (WIC)
Parent(s) filed or will file a 1040A or 1040EZ: Attach a complete signed copy Parent(s) filed or will file a 1040: Attach a signed copy of pages one and two of the parent's tax return. If required to file a Schedule E, you must attach this schedule. Parent(s) filed or will file a Puerto Rican or other foreign tax return: Attach a signed, translated, notarized copy. Convert all figures to U.S. dollars. Parent(s) earned income in 2010 but will not file and is/are not required to file a 2010 federal tax return.
Yes
No
No
Father's total earned in 2010 ( attach W-2 forms) Mother's total earned in 2010 ( attach W-2 forms)
No
Parent(s) did not earn any income in 2010 and did not file an income tax return.
Student filed or will file a 1040A or 1040EZ: Attach a complete signed copy Student filed or will file a 1040: Attach a signed copy of pages one and two of the student's tax return. If required to file a Schedule E, you must attach this schedule. Student filed or will file a Puerto Rican or other foreign tax return: Attach a signed, translated, notarized copy. Convert all figures to U.S. dollars. Student earned income in 2010 but will not file and is/are not required to file a 2010 federal tax return.
No
No
No
Yes
Student did not earn any income in 2010 and did not file an income tax return.
Confirmation #59328-8416
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Parent
Student
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
Parent
Student
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
xxxxxxxxx
$0.00
Confirmation #59328-8416
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Asset Information
Parent(s) Total cash, savings and checking account balances Investments
Real Estate Investments Purchase Date Purchase Price
$30,000 $1,000
Unpaid Mortgage Market Value
Partnerships
Market Value
Debt
Controlling Interest
Real Estate
Share Percentage
Partnerships
Market Value
Debt
Controlling Interest
Real Estate
Confirmation #59328-8416
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Debt
Controlling Interest
Real Estate
Share Percentage
S Corporation
Confirmation #59328-8416
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