Dependent - OSF HealthCare
Saint Francis Medical Center College of NursingStudent Finance Office 511 NE Greenleaf Street Peoria, IL 61603Worksheets for Calendar Year 20192019 Additional Financial InformationStudent/Spouse Report Annual Amounts Parent (If Dependent) Education credits (American Opportunity Tax Credit and Lifetime Learning tax credits) from $__________ IRS Form 1040 Schedule 3—line 3. $__________ Child support paid because of divorce or separation or as a result of a legal requirement. Don’t include support for children in your (or your parents’) household, as reported in $__________ question 95 (Or question 73 for your parent).$__________ Your (or your parents) taxable earnings from need-based employment programs, such as Federal Work-Study and need-based employment portions of fellowships $ __________ and assistantships. $ __________ Taxable college grant and scholarship aid reported to the IRS in your (or your parents’) adjusted gross income. Includes AmeriCorps benefits (awards, living allowances and interest $ __________ accrual payments), as well as grant or scholarship portions of fellowships and assistantships.$ __________ Combat pay or special combat pay. Only enter the amount that was taxable and included $ __________ in your (or your parents’) adjusted gross income. Don’t include untaxed combat pay.$ __________$ _________ Earnings from work under a cooperative education program offered by a college.$ ____________ $__________TOTAL TOTAL$__________ Student’s Signature ________________________________ Date ___________Parent/Stepparent Signature ________________________________ Date ___________ ................
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