2016-2017 SAR Acknowledgement

STUDENT AID REPORT
ACKNOWLEDGEMENT
2016-2017

Dear

OMB No. 1845-0001
DATA RELEASE NUMBER (DRN): 2245
EXPECTED FAMILY CONTRIBUTION (EFC): 000000 C

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WWW.FAFSA.GOV
NOVEMBER 23, 2016
000117C041
JOHN SMITH
742 EVERGREEN TERRACE
SPRINGFIELD OH 55555

JOHN SMITH,

Your Student Aid Report (SAR) Acknowledgement summarizes the information you submitted on your 2016-2017
Free Application for Federal Student Aid (FAFSA).
Application Status (review the checked boxes)
) Your FAFSA appears to be complete. Review the data on pages 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 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)

The data submitted on your FAFSA is used to calculate your Expected Family Contribution (EFC), which is 000000.

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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), work-study (paid part-time employment), and/or low-interest
loans (borrowed funds that must be repaid). 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 StudentAid.gov.
) Based on your EFC it appears that you may be eligible for a Federal Pell Grant of up to $5775, provided you have not
met or exceeded the lifetime limit established for the Federal Pell Grant program. You may also be eligible for other
grants, work-study opportunities, and low-interest student loans. Your Financial Aid Administrator (FAA) will determine
what types of aid and how much you are eligible to receive.
) 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 your Student Aid Report (SAR),
and more”. 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 23, 2017.

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.
43. NET WORTH OF BUSINESS/INVESTMENT FARMS
$ 1,123,446
44. STUDENT'S ADDITIONAL FINANCIAL INFORMATION
a) EDUCATION CREDITS
$ 1,123,446
b) CHILD SUPPORT PAID
$ 1,123,446
c) TAXABLE EARNINGS NEED-BASED EMPLOYMENT
$ 1,123,446
d) STUDENT GRANT AND SCHOLARSHIP AID REPORTED $ 1,123,446
$ 1,123,446
e) COMBAT PAY/SPECIAL COMBAT PAY
f) COOPERATIVE EDUCATION PROGRAM EARNINGS $ 1,123,446
45. STUDENT'S UNTAXED INCOME
$ 1,123,446
a) TAX-DEFERRED PENSION/SAVINGS
$ 1,123,446
b) IRA DEDUCTIONS AND PAYMENTS
$ 1,123,446
c) CHILD SUPPORT RECEIVED
$ 1,123,446
d) TAX-EXEMPT INTEREST INCOME
$ 1,123,446
e) UNTAXED IRA DISTRIBUTIONS
$ 1,123,446
f) UNTAXED PORTIONS OF PENSIONS
$ 1,123,446
g) MILITARY OR CLERGY ALLOWANCES
$ 1,123,446
h) VETERANS NONEDUCATION BENEFITS
$ 1,123,446
i) OTHER UNTAXED INCOME
j) MONEY RECEIVED OR PAID ON YOUR BEHALF
$ 1,123,446
YES
46. BORN BEFORE 1-1-1993?
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 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?
59. PARENTS' MARITAL STATUS UNMARRIED AND BOTH PARENTS LIVING
TOGETHER
DECEMBER 1990
60. PARENTS' MARITAL STATUS DATE
XXX-XX-1234
61. PARENT 1 SOCIAL SECURITY NUMBER
ABCDEFGHIJKLMNOP
62. PARENT 1 LAST NAME
X
63. PARENT 1 FIRST INITIAL
JANUARY 23, 1973
64. PARENT 1 DATE OF BIRTH
XXX-XX-1234
65. PARENT 2 SOCIAL SECURITY NUMBER
ABCDEFGHIJKLMNOP
66. PARENT 2 LAST NAME
67. PARENT 2 FIRST INITIAL
D
68. PARENT 2 DATE OF BIRTH
JANUARY 24, 1972
69. PAR EMAIL [email protected]
70. PARENTS' STATE OF LEGAL RESIDENCE
AB
71. LEGAL RESIDENT BEFORE JANUARY 1, 2011? NO
72. DATE PARENT BECAME LEGAL RESIDENT
DECEMBER 2012

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1. LAST NAME
SMITH
2. FIRST NAME
JOHN
3. MIDDLE INITIAL
4. 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, 1992
10. YOUR TELEPHONE NUMBER
(999)999-9999
11. DRIVER'S LICENSE NUMBER
A-1234-446-789-012-3
12. DRIVER'S LICENSE STATE ABBREVIATION
AB
13. ST E-MAIL
(ELIG NONCIT ASSUMED)
14. CITIZENSHIP STATUS
15. ALIEN REGISTRATION NUMBER
A123446789
(MARRIED ASSUMED)
16. MARITAL STATUS
17. DATE OF MARITAL STATUS
JANUARY 2005
18. STATE OF LEGAL RESIDENCE ABBREVIATION AB
19. LEGAL RESIDENT BEFORE JANUARY 1, 2011? NO
20. DATE YOU BECAME A LEGAL RESIDENT
JANUARY 2012
21. ARE YOU MALE OR FEMALE?
MALE
22. REGISTER YOU FOR SELECTIVE SERVICE?
REGISTER ME
23. DRUG CONVICTION AFFECTING ELIGIBILITY? ELIGIBLE FOR AID
24. PARENT 1 EDUCATIONAL LEVEL
COLLEGE
25. PARENT 2 EDUCATIONAL LEVEL
COLLEGE
26. HIGH SCHOOL COMPLETION STATUS? GED/STATE EQUIVALENT TEST
27.a HS NAME PRINCE GEORGE'S COUNTY HIGH SCHOOL
27.b HS CITY BELTSVILLE
27.c HS STATE MD
28. FIRST BACHELOR'S DEGREE BY 7-1-2016?
YES
29. GRADE LEVEL IN COLLEGE IN 2016-2017
1ST PREV ATTENDED
30. TYPE OF DEGREE/CERTIFICATE
1ST BA
31. INTERESTED IN WORK-STUDY?
YES
32. FILED 2015 INCOME TAX RETURN
WILL FILE
33. TYPE OF 2015 TAX FORM USED
U.S. TRUST TERRITORY
MARRIED-FILED SEPARATE
34. TAX RETURN FILING STATUS 2015
RETURN
35. ELIGIBLE TO FILE 1040A OR 1040EZ?
YES
36. ADJUSTED GROSS INCOME FROM IRS FORM $ (-1,123,446 ASSUMED)
$ (0 ASSUMED)
37. U.S. INCOME TAX PAID
38. EXEMPTIONS CLAIMED
00
39. STUDENT'S INCOME EARNED FROM WORK $ (1,123,446 ASSUMED)
40. SPOUSE'S INCOME EARNED FROM WORK $ (1,123,446 ASSUMED)
41. CASH, SAVINGS, AND CHECKING
$ 1,123,446
42. NET WORTH OF INVESTMENTS
$ 1,123,446

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03
2
YES
YES
YES
95. NUMBER OF FAMILY MEMBERS IN 2016-2017
YES
96. NUMBER IN COLLEGE IN 2016-2017
YES
NO
97. STUDENT RECEIVED SSI?
WILL FILE
98. RECEIVED SNAP?
NO
U.S. TRUST TERRITORY
NO
99. RECEIVED FREE/REDUCED PRICE LUNCH?
MARRIED-FILED SEPARATE 100. RECEIVED TANF?
NO
RETURN
101. RECEIVED WIC?
YES
83. ELIGIBLE TO FILE A 1040A OR 1040EZ?
102. STUDENT OR SPOUSE A DISLOCATED WORKER?
NO
84. EITHER OF PARENTS A DISLOCATED WORKER? YES
103.a FIRST COLLEGE NAME
85. ADJUSTED GROSS INCOME FROM IRS FORM $ (-1,123,456 ASSUMED) THE PENNSYLVANIA STATE UNIVERSITY NEW KENSINGTON CAMPUS COMMON
$ (0 ASSUMED)
86. U.S. INCOME TAX PAID
03
87. EXEMPTIONS CLAIMED
$ (1,123,456 ASSUMED) 103.b FIRST HOUSING PLAN ON CAMPUS
88. PARENT 1 INCOME EARNED FROM WORK
$ (1,123,456 ASSUMED) 103.c SECOND COLLEGE NAME
89. PARENT 2 INCOME EARNED FROM WORK
VIRGINIA POLYTECHNIC INSTITUTE AND STATE UNIVERSITY
$ 1,123,456
90. CASH, SAVINGS, AND CHECKING
$ 1,123,456
91. NET WORTH OF INVESTMENTS
92. NET WORTH OF BUSINESS/INVESTMENT FARMS $ 1,123,456
103.d SECOND HOUSING PLAN OFF CAMPUS
93. PARENTS' ADDITIONAL FINANCIAL INFORMATION
103.e THIRD COLLEGE NAME
$ 1,112,345
a) EDUCATION CREDITS
$ 1,112,345
b) CHILD SUPPORT PAID
UNIVERSITY OF MARYLAND COLLEGE PARK
$ 1,112,345
c) TAXABLE EARNINGS NEED-BASED EMPLOYMENT
d) STUDENT GRANT AND SCHOLARSHIP AID REPORTED $ 1,112,345
103.f THIRD HOUSING PLAN ON CAMPUS
$ 1,112,345
e) COMBAT PAY/SPECIAL COMBAT PAY
103.g FOURTH COLLEGE NAME
$ 1,112,345
f) COOPERATIVE EDUCATION PROGRAM EARNINGS
UNIVERSITY OF MASSACHUSETTS AMHERST
94. PARENTS' UNTAXED INCOME
$ 1,112,345
a) TAX-DEFERRED PENSION/SAVINGS
$ 1,112,345
b) IRA DEDUCTIONS AND PAYMENTS
103.h FOURTH HOUSING PLAN OFF CAMPUS
$ 1,112,345
c) CHILD SUPPORT RECEIVED
NOVEMBER 23, 2016
104. DATE COMPLETED
$ 1,112,345
d) TAX-EXEMPT INTEREST INCOME
STUDENT
$ 1,112,345
105. SIGNED BY
e) UNTAXED IRA DISTRIBUTIONS
$ 1,112,345
f) UNTAXED PORTIONS OF PENSIONS
106. PREPARER'S SOCIAL SECURITY NUMBER REPORTED
REPORTED
$ 1,112,345
g) MILITARY OR CLERGY ALLOWANCES
107. PREPARER'S EIN
SIGNED
$ 1,112,345
108. PREPARER'S SIGNATURE
h) VETERANS NONEDUCATION BENEFITS
$
i) OTHER UNTAXED INCOME
1,112,345
Your FAFSA information was sent to all the 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 your Student Aid Report (SAR), and more".

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73. NUMBER OF FAMILY MEMBERS IN 2016-2017
74. NUMBER IN COLLEGE IN 2016-2017
75. PARENT RECEIVED SSI?
76. RECEIVED SNAP?
77. RECEIVED FREE/REDUCED PRICE LUNCH?
78. RECEIVED TANF?
79. RECEIVED WIC?
80. PARENT(S) FILED 2015 TAX RETURN
81. TYPE OF 2015 TAX FORM USED
82. TAX RETURN FILING STATUS 2015

For Financial Aid Office Use Only

4A
Transaction Source:
Expected Family Contribution: Primary 000000
Y
Verification Flag:
Secondary 000000
Y
Automatic Zero EFC Flag:
Y
SAR C Flag:
2
Formula Type:
Application Receipt Date: 11/23/2016
Y
Simplified Needs Test Flag:
Transaction Process Date: 11/23/2016
Transaction Receipt Date: 11/23/2016
Special Circumstances:
1
Y
High School Flag:
IRS Request Flag: Student: 01 Parent: 01
4
N
SSN Match Flag:
Selective Service Registration Flag:
4
999999999999999
DHS Match Flag:
DHS Verification #:
N
8
DHS Sec. Conf. Flag:
VA Match Flag:
1
2
NSLDS Match Flag:
NSLDS Results Flag:
1
NSLDS Transaction Number:
NSLDS Unusual Enrollment History Flag: 1
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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Professional Judgment:
Dependency Status:
Dependency Override:
Hold Code:
Pell Eligible Flag:
Duplicate SSN Flag:
IRS Display Flag: Student:
Selective Service Match:
SSA Citizenship Code:
P1SSN Match Flag:
P2SSN Match Flag:

Y
X
Y
N
A Parent: C
A
4
8

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