SAR Acknowledgement

STUDENT AID REPORT
ACKNOWLEDGEMENT
2010 - 2011

Dear

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

OMB No. 1845-0008

DATA RELEASE NUMBER (DRN): 2245
EXPECTED FAMILY CONTRIBUTION (EFC): 00000 C

20
09

WWW.FAFSA.GOV
AUGUST 21, 2011
000117C041
JOHN SMITH
742 EVERGREEN TERRACE
SPRINGFIELD OH 55555

JOHN SMITH,

20
,

Your Student Aid Report (SAR) Acknowledgement summarizes the information you submitted on your 2010 - 2011
Free Application for Federal Student Aid (FAFSA).

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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.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.

Federal Student Aid Eligibility (review the checked boxes)

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The data submitted on your FAFSA is used to calculate your Expected Family Contribution (EFC), which is 00000.

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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 (free funds that do not have to be repaid), low-interest loans (borrowed funds that must be repaid), and/or
work-study (paid part-time employment). 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. For more
information about the EFC and other sources of aid, go to www.FederalStudentAid.ed.gov/aidinfo.
) Based on your EFC it appears that you may be eligible for a Federal Pell Grant of up to $5350, in addition to other
grants, low-interest student loans, and work-study opportunities. Your FAA will determine what types of aid and how
much you are eligible to receive.
) You may also be eligible for the Academic Competitiveness Grant (ACG).
) We sent your information to other federal agencies through computer matching programs to verify your eligibility for
federal student aid and there appears to be an issue with the information provided on your application. You can
review information about these issues by going to www.fafsa.gov and selecting “View and Print Your Student Aid
Report.” You must work with your financial aid office to resolve any data matching issues before we can determine if
you are eligible to receive federal student aid.
) Unless you are completing the verification process, it may be too late for you to make corrections or give us any more
information this year. If you are completing verification and you need to correct your information, contact the FAA at
your school for assistance. We must have your corrections no later than September 17, 2011.
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.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, 1986
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, 2005?
20. DATE YOU BECAME A LEGAL RESIDENT
JANUARY 1962
21. ARE YOU MALE OR FEMALE?
MALE
22. REGISTER YOU FOR SELECTIVE SERVICE?
REGISTER ME
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 7-1-2010?
YES
28. GRADE LEVEL IN COLLEGE IN 2010-2011
1ST PREV ATTENDED
29. TYPE OF DEGREE/CERTIFICATE
1ST BA
30. ENROLLMENT STATUS IN 2010-2011
FULL TIME
31. WHAT STUDENT AID TYPES INTEREST YOU?
WORK STUDY
32. COURSEWORK TO BECOME A TEACHER?
DON'T KNOW
33. FILED 2009 INCOME TAX RETURN
WILL FILE
34. TYPE OF 2009 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. STUDENT'S ADDITIONAL FINANCIAL INFORMATION
a) EDUCATION CREDITS
$ 12,344
b) CHILD SUPPORT PAID
$ 12,344
c) TAXABLE EARNINGS NEED-BASED EMPLOYMENT
$ 12,344
d) STUDENT GRANT AND SCHOLARSHIP AID REPORTED $ 12,344
$
e) SPECIAL COMBAT PAY/COMBAT PAY
f) COOPERATIVE EDUCATION PROGRAM EARNINGS $
45. STUDENT'S UNTAXED INCOME
$ 12,344
a) TAX-DEFERRED PENSION/SAVINGS
$ 12,344
b) IRA DEDUCTIONS AND PAYMENTS
$ 12,344
c) CHILD SUPPORT RECEIVED
$ 12,344
d) TAX EXEMPT INTEREST INCOME
$ 12,344
e) UNTAXED IRA DISTRIBUTIONS
$ 12,344
f) UNTAXED PORTIONS OF PENSIONS
$ 12,344
g) MILITARY OR CLERGY ALLOWANCES
$ 12,344
h) VETERANS NON EDUCATION BENEFITS
$ 12,344
i) OTHER UNTAXED INCOME
j) MONEY RECEIVED OR PAID ON YOUR BEHALF
$ 12,344
YES
46. BORN BEFORE 1-1-1987?
YES
47. ARE YOU MARRIED?
48. WORKING ON MASTER'S OR DOCTORATE?
YES
49. ON ACTIVE DUTY IN U.S. ARMED FORCES?
YES
50. VETERAN OF U.S. ARMED FORCES?
YES
YES
51. HAVE CHILDREN YOU SUPPORT?
YES
52. DEPENDENTS OTHER THAN CHILDREN/SPOUSE?
53. PARENTS DECEASED, FOSTER CARE, WARD OF COURT? YES
YES
54. ARE/WERE AN EMANCIPATED MINOR?
YES
55. ARE/WERE IN LEGAL GUARDIANSHIP?
YES
56. VERIFIED AS A HOMELESS CHILD OR YOUTH?
57. DETERMINED BY DEPARTMENT OF HOUSING AND
URBAN DEVELOPMENT THAT YOU WERE HOMELESS?
YES
58. VERIFIED AS UNACCOMPANIED YOUTH AT RISK FOR
YES
HOMELESS?
(MARRIED ASSUMED)
59. PARENTS' MARITAL STATUS
DECEMBER 1958
60. PARENTS' MARITAL STATUS DATE
61. YOUR FATHER'S SOCIAL SECURITY NUMBER XXX-XX-1234
ABCDEFGHIJKLMNOP
62. YOUR FATHER'S LAST NAME
63. YOUR FATHER'S FIRST INITIAL
X
JANUARY 23, 1958
64. YOUR FATHER'S DATE OF BIRTH
65. YOUR MOTHER'S SOCIAL SECURITY NUMBER XXX-XX-1234
ABCDEFGHIJKLMNOP
66. YOUR MOTHER'S LAST NAME

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D
67. YOUR MOTHER'S FIRST INITIAL
93. PARENTS' UNTAXED INCOME
JANUARY 24, 1958
68. YOUR MOTHER'S DATE OF BIRTH
a) TAX-DEFERRED PENSION/SAVINGS
$ 12,345
69. PAR EMAIL [email protected]
$ 12,345
b)
IRA
DEDUCTIONS
AND
PAYMENTS
AB
70. PARENTS' STATE OF LEGAL RESIDENCE
$ 12,345
c) CHILD SUPPORT RECEIVED
71. LEGAL RESIDENT BEFORE JANUARY 1, 2005? DECEMBER 2001
$ 12,345
d) TAX EXEMPT INTEREST INCOME
DECEMBER 2001
72. DATE PARENT BECAME LEGAL RESIDENT
e) UNTAXED IRA DISTRIBUTIONS
$ 12,345
73. NUMBER OF FAMILY MEMBERS IN 2010-2011 03
$ 12,345
f) UNTAXED PORTIONS OF PENSIONS
2
74. NUMBER IN COLLEGE IN 2010-2011
$ 12,345
g) MILITARY OR CLERGY ALLOWANCES
75. PARENT RECEIVED SSI?
YES
$ 12,345
h) VETERANS NON EDUCATION BENEFITS
YES
76. RECEIVED FOOD STAMPS?
$ 12,345
i) OTHER UNTAXED INCOME
77. RECEIVED FREE/REDUCED PRICE LUNCH? YES
03
94. NUMBER OF FAMILY MEMBERS IN 2010-2011
78. RECEIVED TANF?
YES
1
95.
NUMBER
IN
COLLEGE
IN
2010-2011
YES
79. RECEIVED WIC?
YES
96. STUDENT RECEIVED SSI?
WILL FILE
80. PARENT(S) FILED 2009 TAX RETURN
YES
97.
RECEIVED
FOOD
STAMPS?
U.S. TRUST TERRITORY
81. TYPE OF 2009 TAX FORM USED
YES
98. RECEIVED FREE/REDUCED PRICE LUNCH?
YES
82. ELIGIBLE TO FILE A 1040A OR 1040EZ?
YES
99. RECEIVED TANF?
83. EITHER OF PARENTS A DISLOCATED WORKER? YES
YES
100. RECEIVED WIC?
84. ADJUSTED GROSS INCOME FROM IRS FORM $ (-123,456 ASSUMED)
YES
101. STUDENT OR SPOUSE A DISLOCATED WORKER?
85. U.S. INCOME TAX PAID
$ (123,456 ASSUMED)
102.a FIRST COLLEGE NAME 123446789012344678901234467890123446
03
86. EXEMPTIONS CLAIMED
102.b FIRST HOUSING PLAN WITH PARENT
$ (123,456 ASSUMED)
87. FATHER'S INCOME EARNED FROM WORK
102.c SECOND COLLEGE NAME 123446789012344678901234467890123446
88. MOTHER'S INCOME EARNED FROM WORK $ (123,456 ASSUMED)
102.d SECOND HOUSING PLAN WITH PARENT
$ 123,456
89. CASH, SAVINGS AND CHECKING
102.e THIRD COLLEGE NAME 123446789012344678901234467890123446
$ 123,456
90. NET WORTH OF INVESTMENTS
102.f THIRD HOUSING PLAN WITH PARENT
91. NET WORTH OF BUSINESS/INVESTMENT FARMS $ 123,456
102.g FOURTH COLLEGE NAME 123446789012344678901234467890123446
92. PARENTS' ADDITIONAL FINANCIAL INFORMATION
$ 12,345
a) EDUCATION CREDITS
102.h FOURTH HOUSING PLAN WITH PARENT
b) CHILD SUPPORT PAID
$ 12,345
NOVEMBER 23, 2010
103. DATE COMPLETED
$ 12,345
c) TAXABLE EARNINGS NEED-BASED EMPLOYMENT
STUDENT
104. SIGNED BY
d) STUDENT GRANT AND SCHOLARSHIP AID REPORTED $ 12,345
105. PREPARER'S SOCIAL SECURITY NUMBER REPORTED
$ 12,345
e) SPECIAL COMBAT PAY/COMBAT PAY
REPORTED
106. PREPARER'S EIN
$ 12,345
f) COOPERATIVE EDUCATION PROGRAM EARNINGS
SIGNED
107. 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.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: 04/21/2010
Transaction Process Date: 04/21/2010
Transaction Receipt Date: 04/21/2010
4
SSN Match Flag:
DHS Match Flag:
4
8
DHS Sec. Conf. Flag:
2
NSLDS Match Flag:

Expected Family Contribution: Primary 00000
Secondary 00000
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
Y
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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