Alfred University Student Financial Aid Office

Alfred University
One Saxon Drive
phone:
fax:
607·871·2159
607·871·2252
www.alfred.edu
Financial Aid Application Alfred, NY 14802
2016-17
1. Name ____________________________________________________________________________________________________
Last First M.I.
2. Permanent/Home Address

_________________________________________________________ Soc. Sec. No. ______________________________

Street
_________________________________________________________ Email _____________________________________
City State Zip
(_______)_________________________________________________ Cell Phone No. ____________________________
Home Phone (Student’s)

3. Housing Plans for 2016-17

❑ With Parents ❑ Residence Hall ❑ Off Campus ❑ With Relative (please specify) _________________________________

If off campus or with relative, provide address: _______________________________________________________________

4. Citizenship Status Are you a U.S. Citizen? ❑ Yes ❑ No

5. During the 2016-2017 academic year, you will be a

❑ New Freshman ❑ Returning Undergraduate ❑ New Graduate ❑ Special Student (non-degree/non-matriculating)
❑ New Transfer ❑ Returning Graduate ❑ AU Readmit

6. Indicate your intended enrollment status for each semester.

Fall 2016 Spring 2017 Summer 2017

❑ Full-time ❑ Full-time ❑ Full-time
❑ Part-time ❑ Part-time ❑ Part-time
Number of credits? _____ Number of credits? _____ Number of credits? _____
❑ Co-op ❑ Co-op ❑ Co-op
❑ Study abroad ❑ Study abroad ❑ Not attending
❑ Not attending ❑ Not attending

7. Anticipated Graduation Date from Alfred University ________________

Month/Year
8. Other Financial Aid Resources For the 2016-2017 academic year, will you receive any outside financial assistance such as
a private or civic scholarship/grant, non-NY state scholarship/grant, state agency benefits, or tuition benefits from your or your
parents’ employer? ❑ Yes ❑ No If “yes,” identify the type below. Do not include AU Scholarships.

Name of award or benefit source Amount for 2016-2017

__________________________________________________________________________________ $ ________________

__________________________________________________________________________________ $ ________________

9. Please list other colleges to which you have applied (Freshman & transfer students only)

1. _________________________________________________ 4. _______________________________________________

2. _________________________________________________ 5. _______________________________________________

3. _________________________________________________ 6. _______________________________________________
10. Will you receive Veterans Educational Benefits between 7/1/16 and 6/30/17? ❑ Yes ❑ No

If “yes,” specify the type (Chapter and eligibility percent) ________________________________________________________

For questions 11 through 19, if you are required to report parents’ information on the Free Application for Federal
Student Aid (FAFSA), you must also provide parents’ information where requested in this section. Do not leave any
item blank. Enter “0” whenever applicable.

11. Do your parents own all or part of a business or farm? ❑ Yes ❑ No If “yes,” complete a, b, c, d, and e.
If parents own more than one business, provide this for each business on an attached sheet.

a. Type of Business/Farm: ❑ Sole Proprietorship ❑ Partnership ❑ C Corporation ❑ S Corporation

b. Number of full-time employees: __________ c. Parent(s) percent of ownership: ___________

d. If parents do not own 100% of the business, provide the name, percent of ownership and family relationship to parents for
the other owner(s)

(Example: Jack Jones, 50%, Brother) _________________________________________________________________________

e. Farm Owners: Do you live on and operate the farm? ❑ Yes ❑ No

12. Parent Information

a. Are your legal parents (biological/adoptive) currently married and living together in the same household? ❑ Yes □ ❑ No
If “yes”, proceed to number 13. If “no”, complete 12b, 12c, and 12d for your legal parents.

b. Parent #1 ________________________________________________________________________________________________
Name Street City State Zip Code

Parent #2 ________________________________________________________________________________________________
Name Street City State Zip Code

c. Check the box which describes your legal parents’ marital status to each other.
□ ❑ Separated □ ❑ Divorced □ ❑ Not married and not living together ❑ Not married and living together

d. If you checked separated, divorced, or not married and not living together in 12c, complete the following:
1. Name the legal parent in 12b that you lived with most (more than one-half of the time) during the
past 12 months. _________________________________ This person is the custodial parent for financial aid purposes.
Is your custodial parent remarried? □ ❑ Yes □ ❑ No

2. Provide the following for the parent not named in 12d1. This person is the noncustodial parent for financial aid purposes.

______________________________________ ___________________________________ ____________________________

Name Occupation Annual Income

3. File the Alfred University Noncustodial Parent Form. This required form is available at www.alfred.edu or the
AU Financial Aid Office.

13. Does your custodial parent or stepparent, with whom you live, pay child support to another household? ❑ Yes ❑ No
If “yes,” complete a, b, and c. Do not include names or amounts for children included in question 14.

a. Name of parent paying child support. _________________________________________________________________________

b. Annual amount of child support paid in 2015 for all children who do not live in student’s household. $ __________________

c. Name of children for whom payments were made. ______________________________________________________________

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14. Household Member Listing

a. Provide the following information for all family members and other people who now live in your household, and
will continue to live there and receive over one-half of their support from the head(s) of the household for the period
July 1, 2016 to June 30, 2017. Include yourself and your parents. Complete college attendance only if the person will be
enrolled in a program that leads to a college degree or certificate. Indicate both enrollment and student status (FT = Full-
Time, PT = Part-Time, GR = Graduate Student, UG = Undergraduate Student). Part-time means at least 6 credit hours for one
semester during the year.
2016-2017 College Attendance
Date of Enrollment and
Name Age Birth Relationship Name of College Student Status
Self ❑ FT ❑ PT
❑ UG ❑ GR
❑ FT ❑ PT
❑ UG ❑ GR
❑ FT ❑ PT
❑ UG ❑ GR
❑ FT ❑ PT
❑ UG ❑ GR
❑ FT ❑ PT
❑ UG ❑ GR
❑ FT ❑ PT
❑ UG ❑ GR
❑ FT ❑ PT
❑ UG ❑ GR

b. Name any family member in 14a who will live at home while attending college. _____________________________________

c. Specify the type(s) and amount(s) of financial assistance to be received for each household member in 14a who will be
enrolled as a graduate student. For example: Assistanships, tuition waivers, stipends, grants.

15. Home Owners If you are a dependent student, provide the following for your parents. If you are an independent student,
provide the following for yourself and your spouse.

a. Year purchased ____________________________________ e. Monthly home mortgage payment $ ___________________

b. Purchase price $ ____________________________________ f. Is part of the home rented to a nonrelative and included as
rental income and expenses on the federal tax return?
c. Present market value $ _______________________________ ❑ Yes ❑ No

d. Primary mortgage home equity loan balance g. If 15f is yes, provide the percentage of home expenses
attributed to the rental expenses on the tax return.
$ _________________________________________________
$ _________________________________________________

16. Are you or your parents the beneficiary of a trust or estate? ❑ Yes ❑ No If “yes,” complete the following, but do
not include this amount in 19 of this form.

_____________________________________________________ $_______________________ $_______________________

Name of Beneficiary Value of Trust/Estate Annual Income

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17. Breakdown of Federal Tax Return Income
• If 2015 tax returns

are not completed, provide estimates. PARENTS STUDENT AND SPOUSE

Estimated Estimated
2015 2016 2015 2016

a. Wages, salaries, tips (Total of W-2 Father/Student

Forms-Box 5 and IRS Form 1040 (Stepfather)
Lines 12 and 18).
Mother/Spouse
(Stepmother)
b. Interest income (IRS Form 1040-Line 8a,
1040A-Line 8a, or 1040EZ-Line 2).

c. Dividend income (IRS Form 1040-Line 9a
or 1040A-Line 9a).

d. Business and farm income or (loss) (IRS

Form 1040-Lines 12 and 18).

e1. Income or (loss) from rents, partnerships, trusts,

S corporations, etc. (IRS Form 1040-Line 17).

2. Box 14 (Code A) of IRS Schedule K-1 (Form 1065).

f. Other taxable income such as alimony received, capital gains or (losses), pensions, unemployment compensation, social
security, etc. (IRS Form 1040-Lines 10, 11, 13, 14, 15b, 16b, 19, 20b, and 21 or 1040A-Lines 10, 11b, 12b, 13, and 14b or
1040EZ-Line 3). List the 1040/1040A line numbers, sources and amounts below.

1040 Line Number & Source Amount

g. IRA and self-employed SEP, SIMPLE, Keogh and

other qualified plans from IRS Form 1040-total of
Lines 28 and 32 or 1040A-Line 17.

h. Tax-exempt interest income from IRS Form

1040-Line 8b or 1040A-Line 8b.

i. Untaxed portions of IRAs and pensions

from IRS Form 1040-Lines 15a minus 15b and
16a minus 16b or 1040A-Lines 11a minus 11b and
12a minus 12b. Exclude “rollovers.”

j. Untaxed portions of health savings account from

IRS Form 1040-Line 25.

k. Foreign income exclusion from IRS Form

2555-Line 45 or 2555 EZ-Line 18.

l. Education credits from IRS Form

1040-Line 50 or 1040A-Line 33.

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18. Non-Taxable Income Breakdown PARENTS STUDENT AND SPOUSE

Estimated Estimated
2015 2016 2015 2016

a. Payments to tax-deferred pension and savings plans (paid

directly or withheld from earnings), including, but not
limited to, amounts reported on W-2 Form in Boxes 12a
through 12d, codes D, E, F, G, H, and S (Do not include
code DD, Employer Health Insurance Contribution).

b. Untaxed Social Security benefits. Report amount received

for the student in the student column. Report the amount
received for the parents and all other dependent children
in the parents column. Include Supplemental Security
Income. Do not include any amount reported as taxable
on the IRS Form 1040-Line 20b or 1040A-Line 14b.

c. Welfare benefits, including Temporary Assistance for

Needy Families (TANF). Report cash payments only. Do
not report housing subsidies or food stamps.

d. Annual child support amount received for all children.

e. Veteran’s noneducation benefits. Include Disability,

Death Pension, Dependency & Indemnity Compensation
(DIC), and VA Educational Work Study.

f. All other non-taxable income not reported elsewhere on this form. Include untaxed pensions, unemployment, retirement,
and IRA distributions not reported in 17i of this form; workers’ compensation; disability; housing, food and living allowances
paid to members of the military, clergy, and others (include cash payments and cash value of benefits). Do not include the
value of on-base military housing or basic military allowance for housing. List the sources and amounts below.

Source Amount

19. Breakdown of Parents’/Student’s Assets PARENTS STUDENT AND SPOUSE

a. Cash, savings, and checking accounts. $ _________________________ $ _________________________

b. Non-real estate investments. Include UGMA and UTMA

accounts, money market funds, mutual funds, certificates
of deposit, stocks, stock options, bonds, other securities,
installment and land sale contracts (including mortgages $ _________________________ $ _________________________
held), commodities, etc. Do not include the value of life
insurance, retirement plans (non-education IRAs, pension
funds, annuities, Keogh plans, 401(K) plans, etc.), prepaid
tuition plans, or amounts reported in 19a.

c. Provide the value of qualified educational benefits or $ _________________________ $ _________________________

education savings accounts (Coverdell savings accounts,
529 college savings plan and refund value of 529 prepaid
tuition plans). Otherwise, enter “0”.

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20. Other Real Estate Owned Dependent students provide the following for your parents. Independent students provide the
following for yourself and your spouse. Include rental property, land, vacation homes, and second homes. Report amounts for
your percentage of ownership. Do not include the family’s primary residence. Enter “0” if no other real estate is owned.

Market Value Debt Purchase Price Year Purchased Address

$ _______________ $ _______________ $ _______________ _______________ _________________________________

$ _______________ $ _______________ $ _______________ _______________ _________________________________

$ _______________ $ _______________ $ _______________ _______________ _________________________________

21. Do you expect that your or your parents’ total 2016 income will be significantly less than 2015 income? ❑ ❑ Yes ❑ No
If “yes,” attach to this form an explanation of why family income will be less for 2016 and be sure to complete the 2016
estimated income column for numbers 17 and 18 on this application.

22. Have you filed the Free Application for Federal Student Aid? ❑ Yes ❑ No Date filed ________________
(You may file at www.fafsa.gov)

SIGNATURES, CERTIFICATION, AND AUTHORIZATION

Signatures are required of all persons for whom information is submitted on the Alfred University Financial Aid Application
and Free Application for Federal Student Aid. Parent signatures are required for dependent students. If the student is married,
the student’s spouse must also sign.

• I (We) certify that all of the information on this form and any other form submitted in application for financial aid administered
by Alfred University is true and complete to the best of my (our) knowledge, and agree to provide proof, if requested by an
appropriate Alfred University employee. I (We) also realize that if I (we) do not provide proof when asked, the student may be
denied aid.
• I (We) agree to immediately report any changes in the information reported on the Alfred University Financial Aid Application
and Free Application for Federal Student Aid to the Alfred University Student Financial Aid Office. This includes, but is
not limited to, changes in parents’, student’s, and spouse’s income, household size, number of college students; and student’s
address, enrollment status, and housing status.
• I (We) agree to immediately report any non-Alfred University scholarships, grants, or tuition assistance received by the student to
the Alfred University Student Financial Aid Office.
• If selected for an Alfred University scholarship, I understand Alfred University may announce my name and scholarship award
for public relation purposes (example: home town media) or to the donor of endowed and funded awards.

___________________________________________________ ___________________________________________________
Student’s Signature Date Spouse’s Signature Date

___________________________________________________ ___________________________________________________
Father’s (Stepfather’s) Signature Date Mother’s (Stepmother’s) Signature Date

(________)__________________________________________ (________)_________________________________________
Father’s (Stepfather’s) daytime or cell phone number Mother’s (Stepmother’s) daytime or cell phone number

Preferred email for Parent Contact ___________________________________________________

7.2M 11/2015 6