SAR Acknowledgement

WWW.FAFSA.ED.GOV
APRIL 21, 2009
000117C041
JOHN SMITH
742 EVERGREEN TERRACE
SPRINGFIELD, OH 55555

1-800-4-FED-AID (TTY: 1-800-730-8913)

OMB No. 1845-0008

DATA RELEASE NUMBER (DRN): 2245
EXPECTED FAMILY CONTRIBUTION (EFC): 14595 C

JOHN SMITH,

R

Dear

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8

STUDENT AID REPORT
ACKNOWLEDGEMENT
2009 - 2010

BE

Your Student Aid Report (SAR) Acknowledgement summarizes the information you submitted on your 2009 - 2010
Free Application for Federal Student Aid (FAFSA).

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PT
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M

Application Status (review the checked boxes)
Your FAFSA appears to be complete. Review the data on page 2 and 3. We may have assumed certain information to
calculate your eligibility for federal student aid. We printed any assumptions we made and the word "assumed" for the items
on the back of this page. If you need to make corrections, you can go to www.fafsa.ed.gov
and use your Federal Student Aid PIN to access your information or you can contact the financial aid office at one of the
schools you listed on your application for assistance. The school(s) listed on your FAFSA will receive your information.

DA
TE
:

Federal Student Aid Eligibility (review the checked boxes)

The data submitted on your FAFSA is used to calculate your Expected Family Contribution (EFC), which is 14595.
The EFC is not the amount of money that your family must provide. Rather, you should think of the EFC as an index that
colleges use to determine how much financial aid you would receive if you were to attend their school. Financial aid
may include grants, loans, and/or work-study. This award information will vary from college to college because the cost
of attending each is different. Please note that your EFC is subject to change if you update or correct your FAFSA.

DR

AF

T

Based on your EFC it appears that you may be eligible for a Federal Pell Grant. You may also be eligible for other Federal
grants, low-interest student loans, and work-study opportunities.

You should keep this SAR Acknowledgement for your records!
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This section contains information from your student aid application (shaded items display parents' information, if provided). If you
need to make corrections, visit www.fafsa.ed.gov or contact the financial aid office at your college.
1. LAST NAME
SMITH
2. FIRST NAME
JOHN
3. MIDDLE INITIAL
4. PERMANENT ADDRESS 12344 ABCDEFGHIJKLMNOPQRSTUVWXYZABC
5. CITY
ABCDEFGHIJKLMNOP
6. STATE ABBREVIATION
AB
7. ZIP CODE
12345
8. SOCIAL SECURITY NUMBER
XXX-XX-1234
9. DATE OF BIRTH
JANUARY 30, 1900
10. PERMANENT HOME PHONE NUMBER
(999)999-9999
11. DRIVER'S LICENSE NUMBER
A-1234-446-789-012-34
12. DRIVER'S LICENSE STATE ABBREVIATION
AB
13. ST E-MAIL [email protected]
(ELIG. NONCIT ASSUMED)
14. CITIZENSHIP STATUS
15. ALIEN REGISTRATION NUMBER
A123446789
16. MARITAL STATUS
(MARRIED ASSUMED)
17. DATE OF MARITAL STATUS
JANUARY 1993
18. STATE OF LEGAL RESIDENCE ABBREVIATION AB
19. LEGAL RESIDENT BEFORE JANUARY 1, 2004?
20. DATE YOU BECAME A LEGAL RESIDENT
JANUARY 1962
21. ARE YOU MALE OR FEMALE?
MALE
22. REGISTER YOU FOR SELECTIVE SERVICE?
YES
23. DRUG CONVICTION AFFECTING ELIGIBILITY? ELIGIBLE FOR AID
24. FATHER'S EDUCATIONAL LEVEL
COLLEGE
25. MOTHER'S EDUCATIONAL LEVEL
COLLEGE
26. HIGH SCHOOL COMPLETION STATUS?
HS DIPLOMA
27. FIRST BACHELOR'S DEGREE BY 7-1-2009?
YES
28. GRADE LEVEL IN COLLEGE IN 2009-2010
1ST PREV ATTENDED
29. TYPE OF DEGREE/CERTIFICATE
1ST BA
30. ENROLLMENT STATUS IN 2009-2010
FULL TIME
31. WHAT STUDENT AID TYPES INTEREST YOU?
WORK-STUDY
32. COURSEWORK TO BECOME A TEACHER?
DON'T KNOW
33. FILED 2008 INCOME TAX RETURN
WILL FILE
34. TYPE OF 2008 TAX FORM USED
U.S. TRUST TERRITORY
35. ELIGIBLE TO FILE 1040A OR 1040EZ?
YES
36. ADJUSTED GROSS INCOME FROM IRS FORM $ (-123,446 ASSUMED)
37. U.S. INCOME TAX PAID
$ (12,446 ASSUMED)
38. EXEMPTIONS CLAIMED
00
39. STUDENT'S INCOME EARNED FROM WORK $ (123,446 ASSUMED)
40. SPOUSE'S INCOME EARNED FROM WORK $ (123,446 ASSUMED)
41. CASH, SAVINGS, AND CHECKING
$ 123,446
42. NET WORTH OF INVESTMENTS
$ 123,446

999999C999

43. NET WORTH OF BUSINESS/INVESTMENT FARMS
$ 123,446
44. RECEIVE VA BENEFITS BETWEEN 7-1-2009 AND 6-30-2010? YES
45. TYPE OF VA BENEFIT VA CHAPTER 30
46. STUDENT'S ADDITIONAL FINANCIAL INFORMATION
46a. EDUCATION CREDITS
$ 12,344
46b. CHILD SUPPORT PAID
$ 12,344
46c. TAXABLE EARNINGS NEED-BASED EMPLOYMENT $ 12,344
46d. STUDENT GRANT AND SCHOLARSHIP AID REPORTED $ 12,344
$
46e. SPECIAL COMBAT PAY/COMBAT PAY
47. STUDENT'S UNTAXED INCOME
$ 12,344
47a. TAX-DEFERRED PENSION/SAVINGS
$ 12,344
47b. IRA DEDUCTIONS AND PAYMENTS
$ 12,344
47c. CHILD SUPPORT RECEIVED
$ 12,344
47d. TAX EXEMPT INTEREST INCOME
$ 12,344
47e. UNTAXED IRA DISTRIBUTIONS
$ 12,344
47f. UNTAXED PORTIONS OF PENSIONS
$ 12,344
47g. MILITARY OR CLERGY ALLOWANCES
$ 12,344
47h. VETERANS NON EDUCATION BENEFITS
$ 12,344
47i. OTHER UNTAXED INCOME
47j. MONEY RECEIVED OR PAID ON YOUR BEHALF
$ 12,344
YES
48. BORN BEFORE 1-1-1986?
YES
49. ARE YOU MARRIED?
50. WORKING ON MASTER'S OR DOCTORATE?
YES
51. ON ACTIVE DUTY IN U.S. ARMED FORCES?
YES
52. VETERAN OF U.S. ARMED FORCES?
YES
YES
53. HAVE CHILDREN YOU SUPPORT?
YES
54. DEPENDENTS OTHER THAN CHILDREN/SPOUSE?
YES
55. PARENTS DECEASED OR WARD OF COURT?
YES
56. ARE YOU AN EMANCIPATED MINOR?
YES
57. ARE YOU IN LEGAL GUARDIANSHIP?
YES
58. VERIFIED AS A HOMELESS CHILD OR YOUTH?
59. DETERMINED BY DEPARTMENT OF HOUSING AND
URBAN DEVELOPMENT THAT YOU WERE HOMELESS?
YES
60. VERIFIED AS UNACCOMPANIED YOUTH AT RISK FOR
YES
HOMELESS?
(MARRIED ASSUMED)
61. PARENTS' MARITAL STATUS
DECEMBER 1958
62. PARENTS' MARITAL STATUS DATE
63. YOUR FATHER'S SOCIAL SECURITY NUMBER 123-XX-XXXX
ABCDEFGHIJKLMNOP
64. YOUR FATHER'S LAST NAME
65. YOUR FATHER'S FIRST INITIAL
X
JANUARY 23, 1958
66. YOUR FATHER'S DATE OF BIRTH
67. YOUR MOTHER'S SOCIAL SECURITY NUMBER 123-XX-XXXX
ABCDEFGHIJKLMNOP
68. YOUR MOTHER'S LAST NAME

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D
69. YOUR MOTHER'S FIRST INITIAL
JANUARY 24, 1958
70. YOUR MOTHER'S DATE OF BIRTH
71. PAR EMAIL [email protected]
AB
72. PARENTS' STATE OF LEGAL RESIDENCE
$ 12,345
95b. IRA DEDUCTIONS AND PAYMENTS
73. LEGAL RESIDENT BEFORE JANUARY 1, 2004? YES
$ 12,345
DECEMBER 2001
95c. CHILD SUPPORT RECEIVED
74. DATE PARENT BECAME LEGAL RESIDENT
$ 12,345
95d. TAX EXEMPT INTEREST INCOME
75. NUMBER OF FAMILY MEMBERS IN 2009-2010 03
95e. UNTAXED IRA DISTRIBUTIONS
$ 12,345
2
76. NUMBER IN COLLEGE IN 2009-2010
$ 12,345
95f. UNTAXED PORTIONS OF PENSIONS
77. PARENT RECEIVED SSI?
YES
$ 12,345
95g. MILITARY OR CLERGY ALLOWANCES
YES
78. RECEIVED FOOD STAMPS?
$ 12,345
79. RECEIVED FREE/REDUCED PRICE LUNCH? YES
95h. VETERANS NON EDUCATION BENEFITS
$ 12,345
80. RECEIVED TANF?
95i. OTHER UNTAXED INCOME
YES
03
96. NUMBER OF FAMILY MEMBERS IN 2009-2010
YES
81. RECEIVED WIC?
1
97. NUMBER IN COLLEGE IN 2009-2010
WILL FILE
82. PARENT(S) FILED 2008 TAX RETURN
YES
98. STUDENT RECEIVED SSI?
U.S. TRUST TERRITORY
83. TYPE OF 2008 TAX FORM USED
YES
99.
RECEIVED
FOOD
STAMPS?
84. ELIGIBLE TO FILE A 1040A OR 1040EZ?
YES
100. RECEIVED FREE/REDUCED PRICE LUNCH?
85. EITHER OF PARENTS A DISLOCATED WORKER? YES
YES
(-123,456
ASSUMED)
101. RECEIVED TANF?
86. ADJUSTED GROSS INCOME FROM IRS FORM $
YES
102. RECEIVED WIC?
87. U.S. INCOME TAX PAID
$ (123,456 ASSUMED)
YES
103. STUDENT OR SPOUSE A DISLOCATED WORKER?
03
88. EXEMPTIONS CLAIMED
104.a FIRST COLLEGE NAME 123446789012344678901234467890123446
$ (123,456 ASSUMED)
89. FATHER'S INCOME EARNED FROM WORK
90. MOTHER'S INCOME EARNED FROM WORK $ (123,456 ASSUMED)
104.b FIRST HOUSING PLAN WITH PARENT
104.c SECOND COLLEGE NAME 123446789012344678901234467890123446
$ 123,456
91. CASH, SAVINGS AND CHECKING
104.d SECOND HOUSING PLAN WITH PARENT
$ 123,456
92. NET WORTH OF INVESTMENTS
104.e THIRD COLLEGE NAME 123446789012344678901234467890123446
93. NET WORTH OF BUSINESS/INVESTMENT FARMS $ 123,456
104.f THIRD HOUSING PLAN WITH PARENT
94. PARENTS' ADDITIONAL FINANCIAL INFORMATION
$ 12,345
94a. EDUCATION CREDITS
104.g FOURTH COLLEGE NAME 123446789012344678901234467890123446
94b. CHILD SUPPORT PAID
$ 12,345
104.h FOURTH HOUSING PLAN WITH PARENT
$ 12,345
94c. TAXABLE EARNINGS NEED-BASED EMPLOYMENT
NOVEMBER 23, 2009
105. DATE COMPLETED
94d. STUDENT GRANT AND SCHOLARSHIP AID REPORTED $ 12,345
STUDENT
106. SIGNED BY
$ 12,345
94e. SPECIAL COMBAT PAY/COMBAT PAY
107. PREPARER'S SOCIAL SECURITY NUMBER REPORTED
95. PARENTS UNTAXED INCOME
REPORTED
108. PREPARER'S EIN
95a. TAX-DEFERRED PENSION/SAVINGS
$ 12,345
SIGNED
109. PREPARER'S SIGNATURE
Your FAFSA information was sent to all colleges you listed although they are not all shown here. To see all of the colleges you listed go to
www.fafsa.ed.gov and select "View and Print Your Student Aid Report".

For Financial Aid Office Use Only
4A
Transaction Source:
Verification Flag:
Y
Y
SAR C Flag:
Application Receipt Date: 04/21/2009
Transaction Process Date: 04/21/2009
Transaction Receipt Date: 04/21/2009
4
SSN Match Flag:
DHS Match Flag:
4
8
DHS Sec. Conf. Flag:
2
NSLDS Match Flag:

Expected Family Contribution: Primary 00200
Secondary 00199
Y
Automatic Zero EFC Flag:
2
Formula Type:
Y
Simplified Needs Test Flag:
Special Circumstances:
1
N
Selective Service Registration Flag:
DHS Verification #:
999999999999999
N
VA Match Flag:
1
NSLDS Results Flag:
1
NSLDS Transaction Number:

Professional Judgment:
Dependency Status:
Dependency Override:
Hold Code:
Pell Eligible Flag:
Duplicate SSN Flag:
Selective Service Match:
SSA Citizenship Code:
FSSN Match Flag:
MSSN Match Flag:

Y
X
E
N
A
4
8

Reject Code(s): 01 02 03 04 05 06 07
Comment Codes: 001 002 003 004 005 006 007 008 009 010 011 012 013 014 015 016 017 018 019 020
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