Form OMB #1845-0008 ED OMB #1845-0008 ED Student Aid Report - (traditional paper SAR - informatio

Codes for Question 23: TYPE OF DEGREE/CERTIFICATE

Codes for Question 25: ENROLLMENT STATUS

Codes for Question 26: STUDENT AID TYPES

Codes for Question 27: STUDENT HIGH SCHOOL DIPLOMA OR
EQUIVALENT

3. Middle Initial

2. First Name
CHRISTOPHER

1. Last Name
STUDENT

E

4. Permanent Street Address
201 MAIN STREET

6. State Abbreviation
IA

5. City
IOWA CITY

8. Social Security Number
123-45-6789

9. Date of Birth
(BLANK)

7. ZIP Code
52317

Use MM/DD/YYYY
format (e.g., 03/01/1980)

10. Permanent Home Phone Number
(319)555-1234

/

/
11. Driver's License Number
STA7983-IA-0000123008
12. Driver's License State Abbreviation
IA

We will use this e-mail address to correspond with you. You will receive your SAR information through a secure link on the internet. We will only share this
address with the schools you list on the form and your state. Leave blank to receive information through regular mail.
13. Student's E-mail Address
[email protected]

14. Citizenship Status
U.S. CITIZEN

U.S. Citizen

Eligible Noncitizen

Remember to
completely fill
in the oval.

Neither

15. Alien Registration Number
16. Marital Status
BLANK

Single, Divorced or Widowed

17. Date of Marital Status

Use MM/YYYY format (e.g., 03/1980)

20. If you answered "No" to question 19,
date you became a legal resident.

Yes

No

MALE
22. If you are male (age 18-25) and
not registered, answer "Yes" and
Selective Service will register you.

Male

Female

Yes

No

YES
23. Type of Degree/Certificate
1ST BA

/

Separated

21. Are you male or female?

/

18. State of Legal Residence Abbreviation
IA
19. Did you become a legal resident of
this state before January 1, 2003?
YES

Married/Remarried

Enter Code
from Instructions

You Told Us
24. Grade Level in College in 2008-2009?
1ST PREV ATTENDED

Write in Information for New
or Corrected items only.
1st Never Attended.................
1st Previously Attended.........
2nd/Sophomore.....................
3rd/Junior...............................

You Told Us
28. First Bachelor's Degree by 7-1-2008?
YES
29. Father's Educational Level
HIGH SCHOOL

4th/Senior...............................
5th or More.............................
1st Yr. Graduate/Professional
Cont. Graduate/Professional..
25. Enrollment Status in 2008 - 2009
FULL TIME
26. What Student Aid Types Interest You?
WORK-STUDY
27. High School Diploma or equivalent?
HS DIPLOMA

30. Mother's Educational Level
COLLEGE

No

Middle school/Jr. High
High school.................
College or beyond.....

Middle school/Jr. High
High school.................
College or beyond.....
Other/unknown..........

31. Drug Conviction Affecting Eligibility?

Enter Code from Instructions

Yes

Other/unknown..........

Enter Code from Instructions
Enter Code from Instructions

Write in Information for New
or Corrected items only.

(BLANK)

No...............................
Yes (Part-Year)..........

DO NOT LEAVE THIS QUESTION BLANK Yes/Don't Know.........

For 32-45, report your (the student's) income and assets. If you are married as of today, report your and your spouse's income and assets, even if you were not
married in 2007. Ignore references to "spouse" if you are currently single, separated, divorced, or widowed. Remember to completely fill in the oval as follows:
For 38-39, answer the questions whether or not you filed a tax return. This
Have already completed.......
32. Filed 2007 Income Tax Return
information may be on your W-2 forms, or on IRS Form 1040-lines 7+12+18
Will file, have not yet
+ Box 14 of IRS Schedule K-1(Form 1065); 1040A-line 7; or 1040EZ-line 1.
completed..............................
ALREADY COMPLETED
Not going to file......................
38. Student's Income Earned from Work
(Skip to question 38)
$ (999,999 ASSUMED)
,
33. Type of 2007 Tax Form Used
1040

A. IRS 1040.............................
B. IRS 1040A or 1040EZ........
C. A foreign tax return.............
D. A tax return with Puerto Rico,
a U.S. Territory or Freely
Associated State ...............

34. If you filed or will file a 1040, were
Don't
No
you eligible to file a 1040A or 1040EZ? Yes
Know
NO
For 35-47, if the answer is zero or the question does not apply to you, enter 0.
Report dollar amounts (such as $12,356.00) like this:

35. Adjusted Gross Income from IRS Form
(IRS Form 1040-line 37; 1040A-line 21; or
1040EZ-line 4.)
$ (999,999 ASSUMED)
36. U.S. Income Tax Paid from IRS Form
(IRS Form 1040-line 57; 1040A-line 35; or
1040EZ-line 10.)
$ (99,999 ASSUMED)
37. Exemptions Claimed from IRS Form
(1040-line 6d; 1040A-line 6d; for Form
1040EZ see page 2.)
02

,

,

39. Spouse's Income Earned from Work
$ (999,999 ASSUMED)

,

40. Amount from FAFSA Worksheet A
$ 12,345

,

41. Amount from FAFSA Worksheet B
$ 12,345

,

42. Amount from FAFSA Worksheet C
$ 12,345

,

43. Cash, Savings, and Checking
$ 123,456

,

44. Net Worth of Investments
$ 123,456

,

45. Net Worth of Businesses/Investment
Farms
$ 123,456
46. How Many Months VA Education
Benefits Received?
12

,

47. Monthly VA Benefits Amount
$ 1,234

For 48 - 55 write in information for New or Corrected items only.
52. Have dependents other than children
48. Born Before 1-1-1985?
Yes
No
or spouse?
NO (YES ASSUMED)
YES
53. Are your parents deceased, or were you
49. Working on a master's or doctorate
Yes
No
(until age 18) a Ward/Dependent of Court?
program in 2008-2009?
YES
NO (YES ASSUMED)
54. Are you on active duty in U.S Armed
50. Are you married?
Yes
No
Forces?
(YES ASSUMED)
YES
51. Have children who receive more than
55. Are you a veteran of U.S. Armed
Yes
No
half of their support from you?
Forces?
NO
NO

,

Yes

No

Yes

No

Yes

No

Yes

No

Complete this section if you (the student) answered "No" to all questions in Step Three. If you do not live with your two parents, then provide
information about the parent you lived with most during the past year (if that parent is married, provide information about the stepmother or
stepfather to whom that parent is married).

56. Parents' Marital Status
MARRIED/REMARRIED
58. Your Father's/Stepfather's
Social Security Number
XXX-XX--6789

Married/Remarried
Single.....................

Divorced/Separated
Widowed.................

59. Your Father's/Stepfather's Last Name
FULLLASTNAMETEST

57. Date of Marital Status

60. First
Initial
E

61. Father's/Stepfather's Date of Birth
APRIL 03, 1963
/

,
62. Your Mother's/Stepmother's
Social Security Number
XXX-XX--6789

63. Your Mother's/Stepmother's Last Name
FULLLASTNAMETEST

64. First
Initial
E

APRIL 03, 1963

78. If your parents filed or will file a 1040,
were they eligible to file a 1040A or
1040EZ?
NO

68. Parents' state of legal residence
MD
Yes

No

79. Adjusted Gross Income from IRS Form
$ 123,456

80. U.S. Income Tax Paid
70. If "No" to question 69, enter the date
/
$ 123,456
parent became legal resident.
OCTOBER 1997
Use MM/YYYY format (e.g., 03/1980)
81. Exemptions Claimed
71. Parent received Supplemental Security
03
Income (SSI)?
Yes
No
YES
82. Father's/Stepfather's Income
72. Parent received food stamps?
Earned from Work
Yes
No
$ 123,456
YES
83. Mother's/Stepmother's Income
73. Parent received free/reduced price
Earned from Work
Yes
lunch?
No
$ 123,456
YES
84. Amount from FAFSA Worksheet A
74. Parent received Temporary Assistance
$ 12,345
for Needy Families (TANF)?
Yes
No
85. Amount from FAFSA Worksheet B
YES
75. Parent received Nutrition Program for
$ 12,345
Women, Infants and Children(WIC)?
Yes
No
86. Amount from FAFSA Worksheet C
YES
$ 12,345
76. Filed 2007 Income Tax Return
Have already completed
87. Cash, Savings, and Checking
Will file, have not
yet completed..................
WILL FILE
$ 123,456
Not going to file................
88. Net Worth of Investments
77. Type of 2007 Tax Form Used

1040

/

/

Yes............
No..............
Don't Know

For 79-89, if the answer is zero or the question does not apply, enter 0. Report
dollar amounts without cents. For 82-83, this information may be on W-2 forms,
or on IRS Form 1040-lines 7+12+18 + Box 14 of IRS Schedule K-1(Form
1065); 1040A-line 7; or 1040EZ-line 1.

(2 ASSUMED)

69. Parent legal resident of the state
before January 1, 2003?
NO

/

65. Mother's/Stepmother's Date of Birth

,
66. Parents' number of family members
in 2008-2009
(12 ASSUMED)
67. Parents' number of family members
in college in 2008-2009

/

A. IRS 1040........................
B. IRS 1040A or
1040EZ...........................
C. A foreign tax return........
D. A tax return with Puerto Rico,
a U.S. Territory or Freely
Associated State ...........

$ 123,456
89. Net Worth of Businesses/Investment
Farms
$ 123,456

,
,

,
,
,
,
,
,
,
,

90. Number of Family Members in 2008-2009

94. Student received free/reduced price lunch?

02

YES

91. Number in College in 2008-2009
2
92. Student received Supplemental Security
Income (SSI)?
YES
93. Student received food stamps?
YES

You Told Us
97.a First College Name, City and State
ABCDEFGHIJKLMNOPQRSTUVWXYZ
ABCDEFGHIJKLMNOPQRSTUVWXYZ

Yes

No

Yes

No

95. Student received Temporary Assistance
for Needy Families (TANF)?
YES
96. Student received Nutrition Program for
Women, Infants and Children (WIC)?
YES

Yes

No

Yes

No

Yes

No

Housing Plans:
1 -- on campus
2 -- off campus
3 -- with parent

NEW Federal School Code or NEW College Name, City, State
97.b Housing Plans
OFF CAMPUS

97.c Second College Name, City and State
ABCDEFGHIJKLMNOPQRSTUVWXYZ
ABCDEFGHIJKLMNOPQRSTUVWXYZ

97.d Housing Plans
OFF CAMPUS

97.e Third College Name, City and State
ABCDEFGHIJKLMNOPQRSTUVWXYZ
ABCDEFGHIJKLMNOPQRSTUVWXYZ

97.f Housing Plans
OFF CAMPUS

97.g Fourth College Name, City and State
ABCDEFGHIJKLMNOPQRSTUVWXYZ
ABCDEFGHIJKLMNOPQRSTUVWXYZ

97.h Housing Plans
OFF CAMPUS

Your FAFSA information was sent to all schools that you listed although they are not all shown here. To see all of the schools you listed go to www.fafsa.ed.gov and
select "View and Print Your Student Aid Report".
98. Date Completed
DO NOT CORRECT
JANUARY 10, 2008
99. Signed By?
STUDENT

DO NOT CORRECT

100. Preparer's Social Security Number

If this form was filled out by someone
other than you, your spouse, or your
parent(s), that person must complete
this part.

REPORTED
101. Preparer's EIN
REPORTED
102. Preparer's Signature
SIGNED
Application Receipt Date: 01/15/2008
Parent's E-mail Address: [email protected]

If you are the student, by signing this application you certify that you (1) will
use federal and/or state student financial aid only to pay the cost of
attending an institution of higher education, (2) are not in default on a federal
student loan or have made satisfactory arrangements to repay it, (3) do not
owe money back on a federal student grant or have made satisfactory
arrangements to repay it, (4) will notify your school if you default on a federal
student loan, and (5) will not receive a Federal Pell Grant for more than one
school for the same period of time.
If you are the parent or the student, by signing this application you agree, if
asked, to provide information that will verify the accuracy of your completed
form. This information may include your U.S. or state income tax forms that
you filed or are required to file. Also, you certify that you understand that
the Secretary of Education has the authority to verify information
reported on this application with the Internal Revenue Service and other
federal agencies. If you sign any document related to the federal student
aid programs electronically using a Federal Student Aid PIN, you certify that
you are the person identified by the PIN and have not disclosed that PIN to
anyone else. If you purposely give false or misleading information, you may
be fined up to $20,000, sent to prison, or both.
SEND PAGES 5 - 8 OF THIS FORM TO:

Student

Parent

P

*

L

You may also make corrections from
Federal Student Aid's Web site
(www.fafsa.ed.gov). You must use your
PIN to access your record online.

E

94. Student received free/reduced price lunch?

90. Number of Family Members in 2008-2009

YES

02
91. Number in College in 2008-2009
2
92. Student received Supplemental Security
Income (SSI)?
YES

Yes

No

Yes

No

95. Student received Temporary Assistance for
Needy Families (TANF)?
YES
96. Student received Nutrition Program for
Women, Infants and Children (WIC)?
YES

Yes

No

Yes

No

Yes

No

93. Student received food stamps?
YES

You Told Us
97.a First College Name, City and State

Housing Plans:
1 -- on campus
2 -- off campus
3 -- with parent

NEW Federal School Code or NEW College Name, City, State
97.b Housing Plans
OFF CAMPUS

ABCDEFGHIJKLMNOPQRSTUVWXYZ
ABCDEFGHIJKLMNOPQRSTUVWXYZ
97.c Second College Name, City and State
ABCDEFGHIJKLMNOPQRSTUVWXYZ
ABCDEFGHIJKLMNOPQRSTUVWXYZ

97.d Housing Plans
OFF CAMPUS

97.e Third College Name, City and State
ABCDEFGHIJKLMNOPQRSTUVWXYZ
ABCDEFGHIJKLMNOPQRSTUVWXYZ

97.f Housing Plans
OFF CAMPUS

97.g Fourth College Name, City and State
97.h Housing Plans
ABCDEFGHIJKLMNOPQRSTUVWXYZ
OFF CAMPUS
ABCDEFGHIJKLMNOPQRSTUVWXYZ
Your FAFSA information was sent to all schools that you listed although they are not all shown here. To see all of the schools you listed go to www.fafsa.ed.gov
and select "View and Print Your Student Aid Report".
98. Date Completed
JANUARY 10, 2008

DO NOT CORRECT

99. Signed By?
STUDENT

DO NOT CORRECT
If this form was filled out by someone
other than you, your spouse, or your
parent(s), that person must complete
this part.

100. Preparer's Social Security Number
REPORTED
101. Preparer's EIN
REPORTED
102. Preparer's Signature
SIGNED
Application Receipt Date: 01/15/2008
Parent's E-mail Address: [email protected]

Certification:
All of the information on this SAR is true and complete to the best of my
knowledge. If I am asked, I agree to give proof that my information is
correct. The proof might include a copy of the 2007 U.S. Income Tax Form
filed by me or my family. If I sign any document related to the federal
student aid programs electronically using a Federal Student Aid PIN, I certify
that I am the person identified by the PIN and have not disclosed that PIN to
anyone else. I understand that if I purposely give false or misleading
information on this SAR, I may be subject up to a $20,000 fine, a prison
sentence, or both.
If you made no changes:
Do NOT send your SAR to the address given on this page.
Follow the instructions on your SAR. You may need to contact your school.
If you made changes:
You may make corrections from Federal Student Aid's web site
(www.fafsa.ed.gov). You must use your PIN to access your record.

Read the certification statement above and sign to the right.
Send pages 5-8 to: Federal Student Aid Programs
P.O. Box 4694
Mt. Vernon, IL 62864-0064

Student

Parent

P

*

L

If you need another copy of your SAR:
Call the Federal Student Aid Information Center
at 1-800-4-FED-AID (1-800-433-3243)

E