2024-2025 FAFSA Submission Summary FTI Transferred

2024-2025 Free Application for Federal Student Aid (FAFSA)

FAFSA-Submission-Summary_24-25_en_2023-12-06_Output_TransferredFTI

2024-2025 Free Application for Federal Student Aid (FAFSA)

OMB: 1845-0001

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Draft 2023-12-06_Output_TransferredFTI

FAFSA

July 1, 2024 – June 30, 2025

Submission Summary

John William Smith Jr.
742 Evergreen Terrace
Springfield, OH 55555-5555
US

April 05, 2024
Data Release Number (DRN):
9755
Student Aid Index (SAI): 000000*C

Dear John William Smith Jr.,
Your FAFSA Submission Summary shows the information you submitted on your 2024–25 Free Application for Federal Student Aid
(FAFSA) form, which was received on 04/01/2024 and processed on 04/05/2024 . You can use this summary to check your application
status and student aid eligibility (page 1); determine if you need to resolve any problems with your application (page 2); examine
your federal student loan history (page 3); and review or correct the information you provided in your FAFSA form (pages 5–18). See
correction instructions on page 2 and mailing instructions on page 18. For help with this summary, call 1-800-4-FED-AID (1-800-4333243). If you need assistance in another language, visit StudentAid.gov/apply-for-aid/fafsa/filling-out/request-interpreter.

FAFSA Submission Summary

Use this form to review and correct information on your 2024–25 Free Application for Federal
Student Aid (FAFSA ®) form. Or correct your FAFSA information online at fafsa.gov.

Application Status

; Your FAFSA has been selected for verification. Verification is a process where your school confirms the data you reported on
your FAFSA. Your school has the authority to contact you for documentation that supports income and other information that you
reported on your FAFSA.
; Your FAFSA appears to be complete. Review the data on pages 2–18 of your FAFSA Submission Summary and make
corrections or updates if necessary. Any schools listed on your FAFSA will receive your information.
; Your FAFSA has been selected for verification. Verification is a process where your school confirms the data you reported on
your FAFSA. Your school has the authority to contact you for documentation that supports income and other information that you
reported on your FAFSA.

Application Status

Review the checked boxes.
; Your FAFSA appears to be complete. Review the data on pages 2–18 of your FAFSA Submission Summary and make
corrections or updates if necessary. Any schools listed on your FAFSA will receive your information.

Federal Student Aid Eligibility

Colleges use your Student Aid Index (SAI) to determine how much financial aid you could receive if you attended 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). Your SAI may change due to verification or if you update or correct your FAFSA information.

The Internal Revenue Service (IRS) offers tax benefits to help you maximize your college savings or recover some of the money you
spend on tuition or loan interest. For more information, visit StudentAid.gov/resources/tax-benefits.
Review the checked boxes.
; It appears you may be eligible for a Federal Pell Grant of up to $9999, 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 lowinterest student loans.
; There may be issues with your eligibility for federal student aid. Review the checklist on page 2 for instructions on how to
resolve these issues.

Student Aid Eligibility

Your financial aid package could also include other federal, state, or institutional aid. Your school’s financial aid office will tell you
the specific types and amounts of aid you can receive. For more information about the SAI and the types and sources of aid, go to
StudentAid.gov.

; It appears you may be eligible for a Federal Pell Grant of up to $9999, 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 lowinterest student loans.

Draft 2023-12-06_Output_TransferredFTI

2024–25

Comments

Use the checklist below to make sure all your issues are resolved.

The National Student Loan Data System (NSLDS) indicates that one or more of your federal student loans have been discharged. If you have questions, contact the
financial aid office at your school.
If you need to make corrections to your information, you may either make them online at fafsa.gov, or by using this FAFSA Submission Summary. If you need additional
help with this summary, contact your school’s financial aid office or visit fafsa.gov and click the “Help” icon on the FAFSA home page. If your mailing address or email
address changes, you can make the correction online or send in the correction on your FAFSA Submission Summary.
The National Student Loan Data System (NSLDS) indicates that one or more of your federal student loans have been discharged. If you have questions, contact the
financial aid office at your school.
If you need to make corrections to your information, you may either make them online at fafsa.gov, or by using this FAFSA Submission Summary. If you need additional
help with this summary, contact your school’s financial aid office or visit fafsa.gov and click the “Help” icon on the FAFSA home page. If your mailing address or email
address changes, you can make the correction online or send in the correction on your FAFSA Submission Summary.
The National Student Loan Data System (NSLDS) indicates that one or more of your federal student loans have been discharged. If you have questions, contact the
financial aid office at your school.
If you need to make corrections to your information, you may either make them online at fafsa.gov, or by using this FAFSA Submission Summary. If you need
additional help with this summary, contact your school’s financial aid office or visit fafsa.gov and click the “Help” icon on the FAFSA home page. If your mailing address
or email address changes, you can make the correction online or send in the correction on your FAFSA Submission Summary.
The National Student Loan Data System (NSLDS) indicates that one or more of your federal student loans have been discharged. If you have questions, contact the
financial aid office at your school.
If you need to make corrections to your information, you may either make them online at fafsa.gov, or by using this FAFSA Submission Summary. If you need
additional help with this summary, contact your school’s financial aid office or visit fafsa.gov and click the “Help” icon on the FAFSA home page. If your mailing address
or email address changes, you can make the correction online or send in the correction on your FAFSA Submission Summary.

Comments

If you need to make corrections to your information, you may either make them online at fafsa.gov, or by using this FAFSA Submission Summary. If you need additional
help with this summary, contact your school’s financial aid office or visit fafsa.gov and click the “Help” icon on the FAFSA home page. If your mailing address or email
address changes, you can make the correction online or send in the correction on your FAFSA Submission Summary.

The National Student Loan Data System (NSLDS) indicates that one or more of your federal student loans have been discharged. If you have questions, contact the
financial aid office at your school.

You have more comments that were not printed here. For guidance, call 1-800-4-FED-AID (1-800-433-3243).

How to Correct Your Information
• The answer you provided is printed in bold. If you find a mistake,
enter the correct answer in the field.

Use dark ink and write clearly. A computer will process this form; therefore:
• Print in BLOCK CAPITAL letters and only skip a box between words;
for multi-line responses, wrap any incomplete words onto next line:

–

5 0,4 5 9

Mobile phone number 878-456-7890
–
–

1 4 1 6
T

• Report dollar amounts such as $12,356.41 without cents;
if negative, completely fill the circle ( – ) before the answer box:

–

• Fill in both circle and square answer fields completely:

Correct

P L U M

A P T

Continue on next line.

4
1 2,3 5 6

Incorrect x

• For circle answer fields, choose only one response; for square answer fields, choose all that apply:
The edit icon (

√

Corrections

• To delete an answer, draw a line though your answer and through the empty field:

Adjusted gross income $ 53,821

) means you must either correct your answer or, if the original answer is correct, rewrite it exactly in the field.

Write only in defined fields. Information written in blank spaces will not be processed.

Draft 2023-12-06_Output_TransferredFTI

2024–25

Special or Unusual Circumstances

Changes Made to Your FAFSA Information

The financial aid administrator at your college updated the following FAFSA fields to reflect your circumstances. We are sharing this information with
you, but you cannot change it. If you have questions, contact your college’s financial aid office.

Student

Parent

Parent Spouse or Partner

Tax return filing status: Qualifying surviving spouse

Income earned from work: $ 99,999,999,999

Tax exempt interest income: $ 99,999,999,999

Untaxed portions of IRA distributions: $ 99,999,999,999

Untaxed portions of pensions: $ 99,999,999,999

Adjusted gross income: $ –999,999,999

Income tax paid: $ 999,999,999

IRA deductions and S EP/other payments: $ 99,999,999,999 IRA deductions and SEP/other payments: $ 99,999,999,999

IRA deductions and SEP/other payments: $ 99,999,999,999

Education credits: $ 999,999,999

Filed a Schedule A, B, D, E, F, or H: Don’t know

Net profit or loss from Schedule C: $ –99,999,999,999

Special or Unusual Circumstances

If you or your family have experienced special or unusual circumstances that impact your ability to pay for school, you may be eligible for an adjustment
on your FAFSA form. Examples of special circumstances may include: substantial loss of income, changes in assets, tuition expenses at an elementary
or secondary school, or high unreimbursed medical expenses. Examples of unusual circumstances may include: human trafficking, refugee or asylee
status, or parental abuse or abandonment. On a case-by-case basis, your school’s financial aid administrator may determine that your situation justifies
an adjustment to your FAFSA form. Contact your school’s financial aid office to request a review of your circumstances.

Federal Student Loan Summary

Total Amount of Loans Outstanding

FFEL (Bank Loans) and/or Direct Loans
Subsidized Loans
Unsubsidized Loans
Combined Loans
Unallocated Consolidated Loans

Federal Perkins Loans

Total Outstanding Principal Balance
2024–25 Award Year Amount

TEACH Grants Converted to Direct Loans
Unsubsidized Loans

Total Principal
Balance

Amount Pending
Disbursement

Total

$ 999,999
$ 999,999
N/A
N/A

$ 999,999
N/A

N/A
N/A

$ 999,999

N/A

$ 5,000

Federal Student Loan Summary

The table below shows the total amounts of federal (Title IV) student loans that you owe, as reported by your loan servicers. Confirm that these amounts
are correct by signing in to StudentAid.gov and viewing the details for each loan. If you feel the amounts below are incorrect, or you have questions about
a loan, contact the loan servicer indicated on StudentAid.gov. You can find general information about each loan type below at StudentAid.gov/loans.
The “Subsidized” and “Unsubsidized” amounts include those portions of any consolidation loans you have. If there is an amount listed for Federal Family
Education Loan (FFEL) Program “Unallocated Consolidation Loans,” we could not determine whether those balances were subsidized or unsubsidized.
Remember, you are responsible for repaying all of the amounts that you borrow, plus interest. As a general rule, with an assumed interest rate of 5%,
the monthly payment amount over a 10-year repayment period would be approximately $10.61 for every $1,000 that you borrowed. Of course, your
actual repayment amount will depend upon how much you borrow, the interest rate when you enter repayment, and the length of your repayment term.

Office of Management and Budget (OMB) Notice

OMB Notice

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless such collection displays a valid OMB
control number. The valid OMB control number for this information collection is 1845-0001. Public reporting burden for this collection of information is estimated
to average between five and ten minutes per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining
the data needed, and completing and reviewing the collection of information. The obligation to respond to this collection is voluntary. If you have comments or
concerns regarding the status of your individual submission of this form, write directly to the Federal Student Aid Information Center, P.O. Box 84, Washington,
D.C. 20044. (Note: Do not return the completed form to this address.)
By answering question 23, and signing the FAFSA form, you give permission to the U.S. Department of Education to provide information from your application to the
college(s) listed in that question. You also agree that such information is deemed to incorporate by reference the certification statement in the financial aid application.
To learn more about the Privacy Act and how your information may be used, refer to page 4 of the paper FAFSA or the Privacy Act link on StudentAid.gov.
To protect the confidentiality of your application data, you should never give, share, or disclose your FSA ID with anyone, including commercial service providers
that provide assistance with the financial aid process. You should keep your FSA ID in a safe location.

Draft 2023-12-06_Output_TransferredFTI

Federal Tax Information (FTI) Consent and Approval

FTI Consent and Approval

I consent to the disclosure of information about me, as described below, and further affirmatively approve of the receipt and use of my Federal tax
information (FTI) and to the U.S. Department of Education’s redisclosure of my FTI, as described below. By accepting within this summary, I consent
to and affirmatively approve of, as applicable, the following:
1. The U.S. Department of Education may disclose my Social Security number (SSN)/Taxpayer Identification Number (TIN), last name, date of birth,
unique identifier, the tax year for which FTI is required, and the date and timestamp of my approval for the use of my FTI in determining eligibility
by ED for which approval is provided to the U.S. Department of the Treasury, Internal Revenue Service (IRS). I understand that in response to such
a request from the U.S. Department of Education, the IRS shall then disclose my FTI to “authorized persons” (i.e., specifically designated officers
and employees of the U.S. Department of Education and its contractors (as defined in 26 U.S.C. § 6103(l)(13)(E)) for the purpose of determining
eligibility for, and the amount of, Federal student aid under a program authorized under subpart 1 of part A, part C, or part D of title IV of the
Higher Education Act of 1965, as amended, for myself or an applicant for Federal student aid who has requested that I share my FTI on their Free
Application for Federal Student Aid (FAFSA ® ) form.
2. Authorized persons at the U.S. Department of Education and its contractors (as defined in 26 U.S.C. § 6103(l)(13)(E)) may use my FTI for the purpose
of determining the eligibility for, and amount of, Federal student aid under a program authorized under subpart 1 of part A, part C, or part D of title
IV of the Higher Education Act of 1965, as amended, for myself or a FAFSA applicant who has requested that I share my FTI on the FAFSA form.
3. The U.S. Department of Education may redisclose my FTI received from the IRS pursuant to 26 U.S.C. § 6103(l)(13)(D)(iii) to the following entities
solely for the use in the application, award, and administration of financial aid:
• Institutions of higher education participating in the Federal student aid programs authorized under subpart 1 of part A, part C, or part D of title
IV of the Higher Education Act of 1965, as amended;
• State higher education agencies;
• Scholarship organizations designated prior to December 19, 2019, by the Secretary of Education; and
• Contractors of institutions of higher education and State higher education agencies to administer aspects of the institution’s or State agency’s
activities for the application, award, and administration of such financial aid.
4. The U.S. Department of Education may redisclose my FTI to another FAFSA applicant’s FAFSA form(s) for which I elect to participate. By accepting
an invitation and affirmation to participate in another individual’s FAFSA form, my FTI will be redisclosed to the additional application. I understand
that I may decline an invitation to participate, which will prevent the transfer of my FTI to that FAFSA form.
By consenting and providing my affirmative approval, I further understand that:
1. My consent and affirmative approval are required, as a condition of my eligibility or the eligibility of a FAFSA applicant who has requested that I
share my FTI on their FAFSA form, for Federal student aid under a program authorized under subpart 1 of part A, part C, or part D of title IV of the
Higher Education Act of 1965, as amended, even if I did not file a U.S. Federal tax return.
2. I am providing my written consent for the redisclosure of my FTI by the U.S. Department of Education to include, but not limited to, institutions of
higher education, State higher education agencies, designated scholarship organizations, their respective contractors and auditors, other family
members participating in the FAFSA form, Office of Inspector General, under 26 U.S.C. § 6103(l)(13)(D), and with my further express written consent
obtained by an institution of higher education, the redisclosure of FAFSA information pursuant to the terms and conditions of 20 U.S.C. § 1098h(c).
3. Any FTI received from the IRS at a later date shall supersede any manually entered financial or income information on the FAFSA form.
4. The U.S. Department of Education may request updated FTI from the IRS once my consent is provided. If FTI has changed (e.g., amended tax
return filed with revised information), then eligibility for, and amounts of, Federal, State, and institutional financial aid may change.
5. If I do not consent to the redisclosure of my FTI to institutions of higher education, State higher education agencies, designated scholarship
organizations, and their respective contractors, the U.S. Department of Education will be unable to calculate my eligibility for Federal student aid
or the eligibility of a FAFSA applicant who has requested that I share my FTI on their FAFSA form.

2024–25

Signatures

I consent and certify under penalty of perjury under the laws of the United States of America, that the information I provide on the FAFSA form is true and correct.
I understand that any falsification of this statement is punishable under the provisions of 18 U.S.C. § 1001 by a fine, imprisonment of not more than five years, or
both, and that the knowing and willful request for or acquisition of records pertaining to an individual under false pretenses is a criminal offense under the Privacy
Act of 1974, subject to a fine of not more than $5,000 fine (5 U.S.C. § 552(a)(i)(3)). By accepting and submitting my part of the FAFSA, my execution date of
consent and approval will be logged in the U.S. Department of Education’s Person Authentication Service (PAS) System of Record (18-11-12).
If you sign this form, you certify that you are the person identified. If you purposefully give false or misleading information, including applying as an
independent student without meeting the unusual circumstances required to qualify for such a status, you may be subject to criminal penalties under
20 U.S.C. 1097, which may include a fine up to $20,000, imprisonment, or both.
Student
Student, Student Spouse, Parent, Parent Spouse or Partner
By signing this application, you certify that all of the information you
By signing this application, YOU, THE STUDENT, certify that you:
provided is true and complete to the best of your knowledge and you
• will use federal and/or state student financial aid only to pay the cost
agree, if asked to provide:
of attending an institution of higher education,
• information that will verify the accuracy of your completed form, and
• are not in default on a federal student loan or have made satisfactory
arrangements to repay it,
• U.S. or foreign income tax forms that you filed or are required to file.
• do not owe money back on a federal student grant or have made
You also certify that you understand that the Secretary of Education
satisfactory arrangements to repay it,
has the authority to verify information reported on your application with
the Internal Revenue Service and other federal agencies.
• will notify your school if you default on a federal student loan, and
• will not receive a Federal Pell Grant from more than one school for
the same period of time.

Draft 2023-12-06_Output_TransferredFTI

FAFSA

July 1, 2024 – June 30, 2025

2024–25

Submission Summary
OMB No. 1845-0001

Make changes on this paper FAFSA Submission Summary and mail it for processing, or make your changes electronically at fafsa.gov.

Student
Questions 1–24 apply to the student. Leave blank any questions that don’t apply to the student.

Student Identity Information

The student’s full legal name, for example, as it appears on their Social Security card.

First name ABCDEFGHIJKLMNOPQRSTUVWXYZABCDEFGHI
Middle name ABCDEFGHIJKLMNO
Last name ABCDEFGHIJKLMNOPQRSTUVWXYZABCDEFGHI
Date of birth 12/34/5678
/

Social Security number (SSN) XXX-XX-6789
–

–

MM / DD / YYYY

Individual Taxpayer Identification Number (ITIN) XXX-XX-6789
–

–

If the student does not have an ITIN, leave this field blank.

Student

Suffix (e.g., Jr. or III) ABCDEFGHIJ

Student Contact Information

Mobile phone number 123-456-7890
–

–

Email address ABCDEFGHIJKLMNOPQRSTUVWXYZABCDEFGHIJKLMNOPQRSTUVWX
Continue on next line.

Permanent mailing address ABCDEFGHIJKLMNOPQRSTUVWXYZABCDEFGHIJKLMN
Continue on next line.

City ABCDEFGHIJKLMNOPQRSTUVWXYZABCD
ZIP code 12345-6789

Include apt. number.

State AB

Country AB

–

Student Current Marital Status

Separated
Single

(never married)

Married

(not separated)

Remarried

Separated

Divorced

Widowed

Draft 2023-12-06_Output_TransferredFTI

2024–25

Student College or Career School Plans

When the student begins the 2024–25 school year, what will their college grade level be? Master’s or doctorate program
First year undergraduate
(freshman)

Second year undergraduate
(sophomore)

Other undergraduate

(junior year and beyond)

Master’s, doctorate, or graduate certificate
program (MA, MBA, MD, JD, PhD, EdD, etc.)

When the student begins the 2024–25 school year, will they already have their first bachelor’s degree? Yes

Yes

Will the student be pursuing an initial teaching certification at the elementary or secondary level? Yes

Yes

Student Personal Circumstances

Select all that apply.

Active duty, Veteran, Support, Orphan, Ward of court, Foster care, Emancipated minor, Guardianship

The student is currently serving on active duty in the
U.S. armed forces for purposes other than training.
The student is a veteran of the U.S. armed forces.
The student has children or other people (excluding
their spouse) who live with the student and receive
more than half of their support from the student now
and between July 1, 2024, and June 30, 2025.

At any time since the student turned 13, they were an
orphan (no living biological or adoptive parent).

At any time since the student turned 13, they were in foster care.
The student is or was a legally emancipated minor, as determined by a
court in their state of residence.
The student is or was in a legal guardianship with someone other than
their parent or stepparent, as determined by a court in their state of
residence.
None of these apply.

Student Other Circumstances

At any time on or after July 1, 2023, was the student unaccompanied and
either (1) homeless or (2) self-supporting and at risk of being homeless? Yes

Yes

If the answer is “Yes,” did any of the following determine the student was homeless or at risk of becoming homeless?
Select all that apply. Director of homeless program, High school or school district liaison, Director of TRIO/GEAR program, FAA
Director or designee of an emergency
or transitional shelter, street outreach
program, homeless youth drop-in
center, or other program serving those
experiencing homelessness

The student’s
high school or
school district
homeless liaison
or designee

Director or designee of
a project supported by a
federal TRIO or GEAR
UP program grant

Financial aid
administrator
(FAA)

Student

At any time since the student turned 13, they were a ward of the court.

None of
these apply.

Student Unusual Circumstances

Do unusual circumstances prevent the student from contacting their parents or would contacting
Yes
their parents pose a risk to the student? This information will help us evaluate the student’s ability to pay for school. Yes

A student may be experiencing unusual circumstances if they:
• Left home due to an abusive or threatening environment;
• Are a victim of human trafficking;
• Are abandoned by or estranged from their parents;
• Are incarcerated, or their parents are incarcerated, and
contact with the parents would pose a risk to the student; or
• Have refugee or asylee status and are separated from their
parents, or their parents are displaced in a foreign country;
• Are otherwise unable to contact or locate their parents.
If the student’s circumstances resulted in their not having a safe, stable place to live, they may be considered a homeless youth and should review
the answer to question 6 about being unaccompanied and homeless.

Apply for a Direct Unsubsidized Loan Only

Are the student’s parents unwilling to provide their information, but the student doesn’t have an
unusual circumstance, such as those listed in question 7, that prevents them from contacting the
parents or obtaining their information? Yes

Yes

If the answer is “Yes,” a financial aid administrator at the student’s school will determine their eligibility for a Direct Unsubsidized Loan only.
If the student is approved for this option, they will not qualify to receive other types of federal student loans (including Direct Subsidized
Loans), federal grants, or Federal Work-Study programs.

Draft 2023-12-06_Output_TransferredFTI

Family Size

2024–25

How many people are in the student’s family? 12

Include the student (and spouse), the student’s dependent children (even if they live apart due to college enrollment), and other people living with the student now.
Include these dependent children and other people only if the student will provide more than half of their support between July 1, 2024, and June 30, 2025.

Number in College

Student Demographic Information

How many people in the student’s family, including the student, will be in college between July 1, 2024, and June 30, 2025? 12

The answers will not affect the student’s eligibility for federal student aid, be used in any calculations, or be shared with the schools to which the student applies.
They will be used for research purposes only.

What is the student’s gender? Prefer no answer

Male

Female

Nonbinary

Prefer not to answer

“Nonbinary” refers to a student who does not identify exclusively as male or female. “Nonbinary” does not refer to a transgender student who identifies
exclusively as either male or female. Transgender students should select the gender with which they identify at the time this form is completed.

Student Race and Ethnicity

Is the student of Hispanic, Latino, or Spanish origin? Select all that apply. Mexican/Mex Amer/Chicano, Puerto Rican, Cuban, Other
Yes, Mexican,
Mexican American,
or Chicano

Yes, Puerto Rican

Yes, Cuban

Yes, another
Hispanic, Latino,
or Spanish origin

Prefer not
to answer

What is the student’s race? Select all that apply. If you select “Other” and enter more than one category in the entry boxes, skip a box between each one.
White White: German, Irish, English, Italian, Polish, French, Other
German

Irish

English

Italian

Polish

French

Other:

Student

No, not of Hispanic,
Latino, or Spanish
origin

ABCDEFGHIJKLMNOPQRSTUVWXYZABCD
Black or African American Black: African American, Jamaican, Haitian, Nigerian, Ethiopian, Somali, Other
Enter Lebanese, Egyptian, Iranian, etc.

African American

Jamaican

Haitian

Nigerian

Ethiopian

Somali

Other:

ABCDEFGHIJKLMNOPQRSTUVWXYZABCD
Asian Asian: Chinese, Filipino, Asian Indian, Vietnamese, Korean, Japanese, Other
Enter Ghanaian, South African, Barbadian, etc.

Chinese

Filipino

Asian Indian

Vietnamese

Korean

Japanese

Other:

ABCDEFGHIJKLMNOPQRSTUVWXYZABCD
American Indian or Alaska Native American Indian or Alaska Native: Other ABCDEFGHIJKLMNOPQRSTUVWXYZABCD
Enter Pakistani, Cambodian, Hmong, etc.

Other:
Enter name of enrolled or principal tribe(s) (Navajo, Blackfeet, Mayan, Nome Eskimo Community, etc.)

Native Hawaiian or Other Pacific Islander Pacific: Native Hawaiian, Samoan, Chamorro, Tongan, Fijian, Marshallese
Native Hawaiian

Samoan

Chamorro

Other:
Enter Palauan, Tahitian, Chuukese, etc.

Tongan

Fijian

Marshallese

ABCDEFGHIJKLMNOPQRSTUVWXYZABCD

Prefer not to answer Prefer no answer

Student Citizenship

Citizenship status Neither U.S. citizen nor eligible noncitizen
U.S. citizen
or national

Eligible
noncitizen

Neither U.S. citizen nor
eligible noncitizen

A–Number A123456789
A
If the student is an eligible noncitizen, provide their A-Number.

Draft 2023-12-06_Output_TransferredFTI

2024–25

Student State of Legal Residence

State AB

Date the student became a legal resident 12/3456
/

MM / YYYY

Parent Education Status

Did either of the student’s parents attend or complete college? One or both attended, neither completed
Neither parent
attended college

One or both parents attended college,
but neither parent completed college

Parent K ill e d i n L i n e o f D u ty

Student High School Information

One or both parents
completed college

Don’t know

Yes
No
Was the student’s parent or guardian killed in the line of duty while (1) serving on active duty as a
member of the U.S. armed forces on or after September 11, 2001, or (2) performing official duties as a public
Yes
safety officer? The student may be eligible for additional Federal Pell Grant funds once their eligibility is confirmed by their college or career school.

High school completion status when the student begins the 2024–25 school year State-recognized high school equivalent
State-recognized high school equivalent

High school diploma

Homeschooled

(e.g., GED certificate)

None of the previous

If the answer is “High school diploma,” provide the name, city, and state of the high school.
High school name ABCDEFGHIJKLMNOPQRSTUVWXYZABCDEFGHIJKLMNOPQRSTUVWX

Student

Continue on next line.

State AB

City ABCDEFGHIJKLMNOPQRSTUVWXYZAB

If the answer is “State-recognized high school equivalent,”
which of the following did or will the student receive? HiSET

GED

TASC

HiSET

Other

Issuing state
AB

Federal Benefits Received

At any time during 2022 or 2023, did the student or anyone in their family receive benefits from any of
the following federal programs? Select all that apply. EITC, Federal housing, School lunch, Medicaid, QHP, SNAP, SSI, TANF, WIC
Earned income credit (EIC)

Refundable credit for coverage under
a qualified health plan (QHP)

Temporary Assistance for Needy
Families (TANF)

Free or reduced-price school lunch

Supplemental Nutrition
Assistance Program (SNAP)

Special Supplemental Nutrition Program
for Women, Infants, and Children (WIC)

Medicaid

Supplemental Security Income (SSI)

None of these apply.

Federal housing assistance

S t u d e n t Ta x F i l i n g S t a t u s

Did or will the student file a 2022 IRS Form 1040 or 1040-NR? Yes

Yes

Did the student either (1) earn income in a foreign country in 2022, (2) work for an international
organization in 2022 without being required to report income on any tax return, or (3) file a 2022
tax return with Puerto Rico or another U.S. territory? Yes

Yes

International organizations include, for example, the United Nations, World Bank, and International Monetary Fund.
►If the answer is “No” to both of the questions above, and the student is not married, questions 20–22 can be skipped;
however, if the student is also required to provide parent information on the form, question 22 must be answered.

Did or will the student file a 2022 joint tax return with their current spouse? Yes

Yes

S t u d e n t 2 0 2 2 Ta x R e t u r n I n f o r m a t i o n
This space intentionally left blank.

[Question 20 continues on next page.]

Draft 2023-12-06_Output_TransferredFTI
[continued]

2024–25

S t u d e n t 2 0 2 2 Ta x R e t u r n I n f o r m a t i o n

►Convert all currency to U.S. dollars. If the answer is zero or the question does not apply, enter 0.
If the answer is negative, completely fill the circle (

–

) before the answer box.

IRA rollover into another IRA or qualified plan
$ 99,999,999,999
$

Pension rollover into an IRA or other qualified plan
$ 99,999,999,999
$

Did the student receive the earned income credit (EIC)? Don’t know

Yes

IRS Form 1040: line 27

Don’t know

Foreign earned income exclusion $ –999,999,999

Amount of college grants, scholarships, or AmeriCorps
benefits reported as income to the IRS
$ 9,999,999
$

–

IRS Form 1040 Schedule 1: line 8d

The student paid taxes on these grants, scholarships, or benefits. These
usually apply to those renewing their FAFSA form, not to first-time applicants.
If the student is married, include the amount their spouse reported.

Student

This space intentionally left blank.

Annual Child Support Received

Enter total amount the student received in child support for the last complete calendar year. If the answer to question 3 was “Married” or
“Remarried,” enter the combined amount the student and their spouse received. If the answer is zero or the question does not apply, enter 0.

$ 9,999,999

Student Assets

If the answer to question 3 was “Married” or “Remarried,” enter the combined amounts held by the student and their spouse. If the answer is
zero or the question does not apply, enter 0.

Current total of cash, savings,
and checking accounts $ 9,999,999

Current net worth of investments,
including real estate $ 9,999,999

Current net worth of businesses
and investment farms $ 9,999,999

Don't include student financial aid.

Don’t include the home the student lives in.
Net worth is the value of the investments
minus any debts owed against them.

Enter the net worth of the student’s businesses or forprofit agricultural operations. Net worth is the value of the
businesses or farms minus any debts owed against them.

Draft 2023-12-06_Output_TransferredFTI

Colleges

2024–25

Listed below are the colleges that received the student’s FAFSA information. (Other important consumer information can be found at CollegeScorecard.ed.gov.) To stop a
college listed below from receiving the student’s FAFSA information, select the “Remove” box on the right. To have more colleges receive the FAFSA information, add the
new colleges below the list. If all 20 positions are already occupied in the list, you must remove the same number of colleges as the number added; otherwise, the new
colleges will not be added to the student’s record and will not receive the student’s FAFSA information.

Remove

►Family yearly income range key for “Average annual cost”: A: $0–$30,000; B: $30,001–$48,000; C: $48,001–$75,000; D: $75,001–$110,000; E: $110,000+

College 1
College 2
College 3
College 4
College 5
College 6
College 7
College 8
College 9
College 10
College 11

College 13
College 14
College 15
College 16
College 17
College 18
College 19
College 20

Student

College 12

001856 Cornell College - Mt. Vernon, IA. Graduation rate: 74%. Retention rate: 75%. Transfer rate: 3%. Default rate: 3.9%.
Average annual cost: A: $16,806, B: $17,628, C: $21,797, D: $24,390, E: $27,002. Median debt upon graduation: $27,000.
008988 Lurleen B Wallace Community College - Andalusia, AL. Graduation rate: 32%. Retention rate: 63%. Transfer rate: 32%.
Default rate: N/A. Average annual cost: A: $6,864, B: $6,707, C: $8,176, D: $7,961, E: N/A. Median debt upon graduation: N/A.
001856 Cornell College - Mt. Vernon, IA. Graduation rate: 74%. Retention rate: 75%. Transfer rate: 3%. Default rate: 3.9%.
Average annual cost: A: $16,806, B: $17,628, C: $21,797, D: $24,390, E: $27,002. Median debt upon graduation: $27,000.
001856 Cornell College - Mt. Vernon, IA. Graduation rate: 74%. Retention rate: 75%. Transfer rate: 3%. Default rate: 3.9%.
Average annual cost: A: $16,806, B: $17,628, C: $21,797, D: $24,390, E: $27,002. Median debt upon graduation: $27,000.
001856 Cornell College - Mt. Vernon, IA. Graduation rate: 74%. Retention rate: 75%. Transfer rate: 3%. Default rate: 3.9%.
Average annual cost: A: $16,806, B: $17,628, C: $21,797, D: $24,390, E: $27,002. Median debt upon graduation: $27,000.
001856 Cornell College - Mt. Vernon, IA. Graduation rate: 74%. Retention rate: 75%. Transfer rate: 3%. Default rate: 3.9%.
Average annual cost: A: $16,806, B: $17,628, C: $21,797, D: $24,390, E: $27,002. Median debt upon graduation: $27,000.
001856 Cornell College - Mt. Vernon, IA. Graduation rate: 74%. Retention rate: 75%. Transfer rate: 3%. Default rate: 3.9%.
Average annual cost: A: $16,806, B: $17,628, C: $21,797, D: $24,390, E: $27,002. Median debt upon graduation: $27,000.
001856 Cornell College - Mt. Vernon, IA. Graduation rate: 74%. Retention rate: 75%. Transfer rate: 3%. Default rate: 3.9%.
Average annual cost: A: $16,806, B: $17,628, C: $21,797, D: $24,390, E: $27,002. Median debt upon graduation: $27,000.
001856 Cornell College - Mt. Vernon, IA. Graduation rate: 74%. Retention rate: 75%. Transfer rate: 3%. Default rate: 3.9%.
Average annual cost: A: $16,806, B: $17,628, C: $21,797, D: $24,390, E: $27,002. Median debt upon graduation: $27,000.
001856 Cornell College - Mt. Vernon, IA. Graduation rate: 74%. Retention rate: 75%. Transfer rate: 3%. Default rate: 3.9%.
Average annual cost: A: $16,806, B: $17,628, C: $21,797, D: $24,390, E: $27,002. Median debt upon graduation: $27,000.
001856 Cornell College - Mt. Vernon, IA. Graduation rate: 74%. Retention rate: 75%. Transfer rate: 3%. Default rate: 3.9%.
Average annual cost: A: $16,806, B: $17,628, C: $21,797, D: $24,390, E: $27,002. Median debt upon graduation: $27,000.
001856 Cornell College - Mt. Vernon, IA. Graduation rate: 74%. Retention rate: 75%. Transfer rate: 3%. Default rate: 3.9%.
Average annual cost: A: $16,806, B: $17,628, C: $21,797, D: $24,390, E: $27,002. Median debt upon graduation: $27,000.
001856 Cornell College - Mt. Vernon, IA. Graduation rate: 74%. Retention rate: 75%. Transfer rate: 3%. Default rate: 3.9%.
Average annual cost: A: $16,806, B: $17,628, C: $21,797, D: $24,390, E: $27,002. Median debt upon graduation: $27,000.
001856 Cornell College - Mt. Vernon, IA. Graduation rate: 74%. Retention rate: 75%. Transfer rate: 3%. Default rate: 3.9%.
Average annual cost: A: $16,806, B: $17,628, C: $21,797, D: $24,390, E: $27,002. Median debt upon graduation: $27,000.
001856 Cornell College - Mt. Vernon, IA. Graduation rate: 74%. Retention rate: 75%. Transfer rate: 3%. Default rate: 3.9%.
Average annual cost: A: $16,806, B: $17,628, C: $21,797, D: $24,390, E: $27,002. Median debt upon graduation: $27,000.
001856 Cornell College - Mt. Vernon, IA. Graduation rate: 74%. Retention rate: 75%. Transfer rate: 3%. Default rate: 3.9%.
Average annual cost: A: $16,806, B: $17,628, C: $21,797, D: $24,390, E: $27,002. Median debt upon graduation: $27,000.
001856 Cornell College - Mt. Vernon, IA. Graduation rate: 74%. Retention rate: 75%. Transfer rate: 3%. Default rate: 3.9%.
Average annual cost: A: $16,806, B: $17,628, C: $21,797, D: $24,390, E: $27,002. Median debt upon graduation: $27,000.
001856 Cornell College - Mt. Vernon, IA. Graduation rate: 74%. Retention rate: 75%. Transfer rate: 3%. Default rate: 3.9%.
Average annual cost: A: $16,806, B: $17,628, C: $21,797, D: $24,390, E: $27,002. Median debt upon graduation: $27,000.
001856 Cornell College - Mt. Vernon, IA. Graduation rate: 74%. Retention rate: 75%. Transfer rate: 3%. Default rate: 3.9%.
Average annual cost: A: $16,806, B: $17,628, C: $21,797, D: $24,390, E: $27,002. Median debt upon graduation: $27,000.
001856 Cornell College - Mt. Vernon, IA. Graduation rate: 74%. Retention rate: 75%. Transfer rate: 3%. Default rate: 3.9%.
Average annual cost: A: $16,806, B: $17,628, C: $21,797, D: $24,390, E: $27,002. Median debt upon graduation: $27,000.

On this FAFSA Submission Summary up to three colleges can be added. At fafsa.gov up to 20 colleges can be added.

New College 1

Federal School Code

New College 2

Federal School Code

New College 3

Federal School Code

College
name

Address
and city
College
name

Address
and city

Student Consent, Approval, and Signature

State

[See page 4.]

Refer to the terms on page 4. By filling in the answer circle below and signing this summary, you (the student) agree to the terms set forth on page 4.
If you do not provide approval by filling in the circle below and providing your signature, you will not be eligible for federal student aid.
Approval to transfer federal tax information from the Internal Revenue Service (IRS) No approval given

Student signature

Date signed
/

MM / DD / YYYY

Draft 2023-12-06_Output_TransferredFTI
Student

2024–25

Spouse

Questions 25–29 apply to the student’s spouse. Leave blank any questions that don’t apply to the student’s spouse.

Student Spouse Identity Information

The student spouse’s full legal name, for example, as it appears on their Social Security card.

First name ABCDEFGHIJKLMNOPQRSTUVWXYZABCDEFGHI
Middle name ABCDEFGHIJKLMNO
Last name ABCDEFGHIJKLMNOPQRSTUVWXYZABCDEFGHI
Suffix (e.g., Jr. or III) ABCDEFGHIJ

Date of birth 12/34/5678
/

Social Security number (SSN) XXX-XX-6789
–

If the student spouse does not have an SSN,
enter all zeros.

MM / DD / YYYY

Individual Taxpayer Identification Number (ITIN) XXX-XX-6789
–

–

If the student spouse does not have an ITIN, leave this field blank.

Student

Student Spouse Contact Information

Mobile phone number 123-456-7890
–

S pouse

–

Email address ABCDEFGHIJKLMNOPQRSTUVWXYZABCDEFGHIJKLMNOPQRSTUVWX
Continue on next line.

Permanent mailing address ABCDEFGHIJKLMNOPQRSTUVWXYZABCDEFGHIJKLMN
Continue on next line.

City ABCDEFGHIJKLMNOPQRSTUVWXYZABCD
ZIP code 12345-6789

Include apt. number.

State AB

Country AB

–

S t u d e n t S p o u s e Ta x F i l i n g S t a t u s

Did or will the student’s spouse file a 2022 IRS Form 1040 or 1040-NR? Yes

Yes

Did the student spouse either (1) earn income in a foreign country in 2022, (2) work for an
international organization in 2022 without being required to report income on any tax return,
or (3) file a 2022 tax return with Puerto Rico or another U.S. territory? Yes

No
Yes

International organizations include, for example, the United Nations, World Bank, and International Monetary Fund.
►If the answer is “No” to both of the questions above, question 28 can be skipped.

Draft 2023-12-06_Output_TransferredFTI

2024–25

S t u d e n t S p o u s e 2 0 2 2 Ta x R e t u r n I n f o r m a t i o n
This space intentionally left blank.

►Convert all currency to U.S. dollars. If the answer is zero or the question does not apply, enter 0.
If the answer is negative, completely fill the circle (

–

) before the answer box.

IRA rollover into another IRA or qualified plan
$ 99,999,999,999
$

Pension rollover into an IRA or other qualified plan
$ 99,999,999,999
$

Foreign earned income exclusion $ –999,999,999
–

This space intentionally left blank.

IRS Form 1040 Schedule 1: line 8d

Student

S pouse

This space intentionally left blank.

Student Spouse Consent, Approval, and Signature

[See page 4.]

Refer to the terms on page 4. By filling in the answer circle below and signing this summary, you (the student spouse) agree to the terms set forth on page 4.
If you do not provide approval by filling in the circle below and providing your signature, the student will not be eligible for federal student aid.
Approval to transfer federal tax information from the Internal Revenue Service (IRS) No approval given

Student spouse signature

Date signed
/

MM / DD / YYYY

Draft 2023-12-06_Output_TransferredFTI

2024–25

Parent
Questions 30–41 apply to the student’s parent. Leave blank any questions that don’t apply to the parent.

Parent Identity Information

The parent’s full legal name, for example, as it appears on their Social Security card.

First name ABCDEFGHIJKLMNOPQRSTUVWXYZABCDEFGHI
Middle name ABCDEFGHIJKLMNO
Last name ABCDEFGHIJKLMNOPQRSTUVWXYZABCDEFGHI
Suffix (e.g., Jr. or III) ABCDEFGHIJ

Date of birth 12/34/5678
/

Social Security number (SSN) XXX-XX-6789
–

–

If the parent does not have an SSN, enter all zeros.

MM / DD / YYYY

Individual Tax Identification Number (ITIN) XXX-XX-6789
–

–

If the parent does not have an ITIN, leave this field blank.

Parent

Parent Contact Information

Mobile phone number 123-456-7890
–

–

Email address ABCDEFGHIJKLMNOPQRSTUVWXYZABCDEFGHIJKLMNOPQRSTUVWX
Continue on next line.

Permanent mailing address ABCDEFGHIJKLMNOPQRSTUVWXYZABCDEFGHIJKLMN
Continue on next line.

Include apt. number.

City ABCDEFGHIJKLMNOPQRSTUVWXYZABCD
ZIP code 12345-6789

State AB

Country AB

–

Parent Current Marital Status

Unmarried and both legal parents living together
Single

(never married)

Unmarried and both legal
parents living together

Married

(not separated)

Remarried

Separated

Divorced

Widowed

Parent State of Legal Residence

State AB

Date the parent became a legal resident 12/3456
/

MM / YYYY

Draft 2023-12-06_Output_TransferredFTI

Family Size

2024–25

How many people are in the parent’s family? 12
Include the parent (and spouse or partner), the student, the parent’s dependent children (even if they live apart because of
college enrollment), and other people living with the parent now. Include these dependent children and other people only if
the parent will provide more than half of their support between July 1, 2024, and June 30, 2025.

Number in College

How many people in the parent’s family will be in college between July 1, 2024, and June 30, 2025? 12
Do not include parent(s).

Federal Benefits Received

At any time during 2022 or 2023, did the parent or anyone in their family receive benefits from any of the following
federal programs? Select all that apply. EITC, Federal housing, School lunch, Medicaid, QHP, SNAP, SSI, TANF, WIC
Earned income credit (EIC)

Refundable credit for coverage under
a qualified health plan (QHP)

Temporary Assistance for Needy
Families (TANF)

Free or reduced-price school lunch

Supplemental Nutrition
Assistance Program (SNAP)

Special Supplemental Nutrition Program
for Women, Infants, and Children (WIC)

Medicaid

Supplemental Security Income (SSI)

None of these apply.

Federal housing assistance

P a r e n t Ta x F i l i n g S t a t u s

Did or will the parent file a 2022 IRS Form 1040 or 1040-NR? Yes

Yes

If the answer is “No,” indicate which one of the following situations applies to the parent for 2022: Income below threshold
►If one of the options in the second column below is selected and the parent is unmarried, questions 38–40 can be skipped.
The parent filed or will file a tax return with Puerto Rico
or another U.S. territory.

The parent, even though they earned income in the
U.S., did not and will not file a U.S. tax return because
their income was below the tax filing threshold.

The parent filed or will file a foreign tax return.

The parent did not and will not file a U.S. tax return
for reasons other than low income.

The parent either earned income in a foreign country but did not
and will not file a foreign tax return, or worked for an international
organization and was not required to report income on any tax return.

The parent did not and will not file any tax
return because they did not earn any income.

International organizations include, for example, the United Nations,
World Bank, and International Monetary Fund.

Did or will the parent file a 2022 joint tax return with their current spouse? Yes

Parent

Yes

P a r e n t 2 0 2 2 Ta x R e t u r n I n f o r m a t i o n
This space intentionally left blank.

►Convert all currency to U.S. dollars. If the answer is zero or the question does not apply, enter 0.
If the answer is negative, completely fill the circle (

–

) before the answer box.

IRA rollover into another IRA or qualified plan
$ 99,999,999,999
$

Pension rollover into an IRA or other qualified plan
$ 99,999,999,999
$

Did the parent receive the earned income credit (EIC)? Don’t know

Yes

IRS Form 1040: line 27

Amount of college grants, scholarships, or AmeriCorps
benefits reported as income to the IRS
$ 9,999,999
$

Don’t know

Foreign earned income exclusion $ –999,999,999
–

IRS Form 1040 Schedule 1: line 8d

The parent paid taxes on these grants, scholarships, or benefits. These
usually apply to those renewing their FAFSA form, not to first-time applicants.
If the parent is married, include the amount their spouse reported.

[Question 38 continues on next page.]

Draft 2023-12-06_Output_TransferredFTI
[continued]

2024–25

P a r e n t 2 0 2 2 Ta x R e t u r n I n f o r m a t i o n

This space intentionally left blank.

Parent

Annual Child Support Received

Enter total amount the parent received in child support for the last complete calendar year. If the answer to question 32 was “Married,”
“Remarried,” or “Unmarried and both legal parents living together,” enter the combined amount the parent and their spouse received.
If the answer is zero or the question does not apply, enter 0.

$ 9,999,999

Parent Assets

If the answer to question 32 was “Married,” “Remarried,” or “Unmarried and both legal parents living together,” enter the
combined amounts held by the parent and their spouse. If the answer is zero or the question does not apply, enter 0.

Current total of cash, savings,
and checking accounts $ 9,999,999

Current net worth of investments,
including real estate $ 9,999,999

Current net worth of businesses
and investment farms $ 9,999,999

Don't include student financial aid.

Don’t include the home the parent lives in.
Net worth is the value of the investments
minus any debts owed against them.

Enter the net worth of the parent’s businesses or forprofit agricultural operations. Net worth is the value of the
businesses or farms minus any debts owed against them.

Parent Consent, Approval, and Signature

[See page 4.]

Refer to the terms on page 4. By filling in the answer circle below and signing this summary, you (the parent) agree to the terms set forth on page 4.
If you do not provide approval by filling in the circle below and providing your signature, the student will not be eligible for federal student aid.
Approval to transfer federal tax information from the Internal Revenue Service (IRS) No approval given

Parent signature

Date signed
/

MM / DD / YYYY

Draft 2023-12-06_Output_TransferredFTI
Parent

2024–25

Spouse or Partner

►Do not complete this section if you are not the student’s legal parent or stepparent.
Questions 42–46 apply to the parent spouse or partner. Leave blank any questions that don’t apply to the parent spouse or partner.

Parent Spouse or Partner Identity Information

The parent spouse or partner’s full legal name, for example, as it appears on their Social Security card.

First name ABCDEFGHIJKLMNOPQRSTUVWXYZABCDEFGHI
Middle name ABCDEFGHIJKLMNO
Last name ABCDEFGHIJKLMNOPQRSTUVWXYZABCDEFGHI
Suffix (e.g., Jr. or III) ABCDEFGHIJ

Date of birth 12/34/5678
/

–

MM / DD / YYYY

Individual Taxpayer Identification Number (ITIN) XXX-XX-6789
–

Social Security number (SSN) XXX-XX-6789
–

If the parent spouse or partner does not have
an SSN, enter all zeros.

–

If the parent spouse or partner does not have an ITIN, leave this field blank.

Parent Spouse or Partner Contact Information

Parent

Mobile phone number 123-456-7890
–

–

Continue on next line.

Permanent mailing address ABCDEFGHIJKLMNOPQRSTUVWXYZABCDEFGHIJKLMN
Continue on next line.

City ABCDEFGHIJKLMNOPQRSTUVWXYZABCD
ZIP code 12345-6789

Include apt. number.

State AB

Country AB

–

P a r e n t S p o u s e o r P a r t n e r Ta x F i l i n g S t a t u s

Did or will the parent spouse or partner file a 2022 IRS Form 1040 or 1040-NR? Yes

Yes

S pouse or Partner

Email address ABCDEFGHIJKLMNOPQRSTUVWXYZABCDEFGHIJKLMNOPQRSTUVWX

If the answer is “No,” indicate which one of the following situations applies to the parent spouse or partner for 2022:
►If one of the options in the second column below is selected, question 45 can be skipped. Income below threshold
The parent spouse or partner filed or will file a tax return
with Puerto Rico or another U.S. territory.
The parent spouse or partner filed or will file a foreign tax return.
The parent spouse or partner either earned income in a foreign country but
did not and will not file a foreign tax return, or worked for an international
organization and was not required to report income on any tax return.
International organizations include, for example, the United Nations,
World Bank, and International Monetary Fund.

The parent spouse or partner, even though they earned
income in the U.S., did not and will not file a U.S. tax return
because their income was below the tax filing threshold.
The parent spouse or partner did not and will not file a
U.S. tax return for reasons other than low income.
The parent spouse or partner did not and will not file any
tax return because they did not earn any income.

15
16

Draft 2023-12-06_Output_TransferredFTI

2024–25

P a r e n t S p o u s e o r P a r t n e r 2 0 2 2 Ta x R e t u r n I n f o r m a t i o n
This space intentionally left blank.

►Convert all currency to U.S. dollars. If the answer is zero or the question does not apply, enter 0.
If the answer is negative, completely fill the circle (

–

) before the answer box.

IRA rollover into another IRA or qualified plan
$ 99,999,999,999
$

Pension rollover into an IRA or other qualified plan
$ 99,999,999,999
$

Foreign earned income exclusion $ –999,999,999
–

This space intentionally left blank.

IRS Form 1040 Schedule 1: line 8d

Parent

S pouse or Partner

This space intentionally left blank.

Parent Spouse or Partner Consent, Approval, and Signature

[See page 4.]

Refer to the terms on page 4. By filling in the answer circle below and signing this summary, you (the parent spouse or partner) agree to the terms set forth on page 4.
If you do not provide approval by filling in the circle below and providing your signature, the student will not be eligible for federal student aid.
Approval to transfer federal tax information from the Internal Revenue Service (IRS) No approval given

Parent spouse or partner signature

Date signed
/

MM / DD / YYYY

Draft 2023-12-06_Output_TransferredFTI

Preparer
47

Preparer Identity Information

First name ABCDEFGHIJKLMNOPQRSTUVWXYZABCDEFGHI Last name ABCDEFGHIJKLMNOPQRSTUVWXYZABCDEFGHI
Social Security number (SSN) XXX-XX-6789

Employer Identification Number (EIN) 12-3456789

Preparer Contact Information

Preparer

If someone other than the applicant completed the FAFSA form on the applicant’s behalf, that person’s information appears in this
section. Paid preparers are prohibited.

2024–25

Affiliation / Organization ABCDEFGHIJKLMNOPQRSTUVWXYZABCD
Permanent mailing address ABCDEFGHIJKLMNOPQRSTUVWXYZABCDEFGHIJKLMN
City ABCDEFGHIJKLMNOPQRSTUVWXYZABCD

ZIP code 12345-6789

State AB

Preparer Signature

Preparer signature Signed

Date signed 04/15/2022

Mail Your FAFSA Submission Summary
If you made changes on this summary, photocopy pages 5–18 for your records and then mail the original of those pages to:
Federal Student Aid Programs, P.O. Box 70204, London, KY 40742-0204

Extra postage will be required. After your FAFSA Submission Summary is processed, you will receive an updated summary. If
you (the student) provided an email address (page 5), we will notify you within three to five days that your updated summary
is available at StudentAid.gov. If you did not provide an email address, your summary will be mailed to you within three weeks. If
you would like to check the processing status of your corrections, go to StudentAid.gov or call 1-800-4-FED-AID (1-800-433-3243).

College Use Only
Federal school code

D/O

FAA signature

Data Entry Use Only
*

File Type	application/pdf
File Modified	2023-12-06
File Created	2023-12-06