University of Wisconsin - Madison



University of Wisconsin - Madison

STUDENT 2010 FEDERAL TAX RETURN COVER FORM

(Complete this form even if you aren’t required to file a Federal Tax Return)

Student Name: _____________________________________________UW Campus ID: __ __ __ - __ __ __ - __ __ __ __

last first middle

STUDENT: complete item I. If you are married or a single parent student complete items I AND II.

I. STUDENT – Check box “A” or “B

A. θ I have attached a SIGNED photocopy of my 2010 Federal Income Tax Return, including all schedules, or a SIGNED electronic declaration.

Does the income on your tax return include work-study earnings? θyes $_________ θno

OR

B. θ I hereby certify I DID NOT AND AM NOT REQUIRED to file a Federal Tax Return for 2010 and I’ve listed

an accurate account of my 2010 income in the section below. SIGN below and complete items 1 and 2.

SIGN HERE if you checked box “B” _________________________________________ ____________

(Date)

1. If you checked box “B” please list each 2010 employer or source of income (if married as of the date you complete the FAFSA include spouse’s income). If you had no income (taxable or nontaxable) in 2010, write “none”.

Employer(s)/Source of Income Amount received

_____________________________________________________ $_____________

_____________________________________________________ $_____________

2. If you listed amounts above, do any of the amounts include work-study earnings? θyes θno $___________

II. MARRIED OR SINGLE PARENT STUDENTS ONLY

Include yourself, spouse and other family members for whom you supply over one-half support.

|Full name of family member |Age |Family member’s |Lives with|Monthly day |Will attend college at |Name of college |Year in college|

| | |relationship to student|you? |care costs |least ½ time in 2011-2012?| |of this person |

|1) ____________________ | | | |$ |yes ( no θ | | |

|Student Applicant | | | | | | | |

|3) | | | |$ |yes θ no θ | | |

III. Special Circumstances for STUDENT - Complete this section ONLY if there are special circumstances we should take into consideration when reviewing your application. Examples include loss of a job, a death in the family, or exceptionally high medical/dental expenses.

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

I certify that all the information I provide to the UW-Madison Office of Student Financial Aid is true, correct and complete. I authorize that office to obtain any additional information needed to complete the processing of my application, and to release information to others who may consider me for financial assistance or make decisions related to my educational plans.

Signature: _____________________________________________________________________ Date: _____________

PAPER-CLIP a SIGNED copy of your 2010 Federal Income Tax Return to this cover form

INSTRUCTIONS

Send us a SIGNED photocopy of your 2010 Federal Income Tax Return (1040, 1040A, or 1040EZ), including W-2 form(s) and all schedules, as filed with the Internal Revenue Services (IRS). Paper-clip the tax returns to this form and send it directly to our office. State income tax returns are not acceptable.

If you are submitting an electronic declaration we must have your signature someplace on the form even though you aren’t required to sign it for filing purposes.

If you filed a foreign tax return make sure it is signed and paper-clip it to this form.

Students who DID NOT AND ARE NOT REQUIRED to file a tax return for 2010 must SIGN section B and return the Student 2010 Federal Tax Return Cover Form to our office.

Students who were not married when they filed their 2010 Federal Income Tax Return but are married as of the date they complete the FAFSA must submit a signed copy of their spouse's 2010 Federal Income Tax Return in addition to their own. Also, if you are currently required to provide parental information for financial aid, you may want to wait to file the FAFSA until after you are married. Married students are considered self-supporting (no parental information required) and marital status is determined as of the date you sign the FAFSA.

If you filed a 2010 Federal Tax Return, but did not keep a copy, obtain a copy from the person who prepared your return or the Internal Revenue Service (IRS). To obtain a copy from the IRS, contact them at 1-800-829-3676 or 1-800-829-1040. A tax return transcript of Form 1040 series may be obtained from the IRS and there is no charge for this form. Be sure you SIGN the tax return transcript before submitting to our office.

Return to: UW-Madison

Office of Student Financial Aid

333 East Campus Mall #9701

Madison WI 53715-1382

Fax: 608-262-9068

Unsigned tax returns will be returned to you.

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