Simplified FAFSA - Prototype (MS Word)
FAFSA Free Application for Federal Student Aid
|Section 1: Student Demographics |
|Q1. Student’s Full Name |
|[pic] [pic] [pic] |
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|Q2. Student’s Permanent Address [pic] |
|[pic] [pic] [pic] |
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|Q3. Student’s Telephone Number |Q4. Student’s State of Legal Residence |
|[pic] |[pic] |
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|Q5. Student’s Email Address |
|[pic] |
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|Q6. Student’s Social Security Number |Q7. Student’s Date of Birth |
|[pic] |[pic] |
|Section 2: Student Eligibility |
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|Q8a. Student’s Citizenship Status |Q8b. Student’s Alien Registration Number |
|I am a U.S. Citizen (US natural) |[pic] |
|I am an eligible non-citizen | |
|I am not a U.S citizen or an eligible non-citizen | |
| |
|Q9. Are you male or female? Most male students must be registered with Selective Service to get federal aid. If you Male ___ Female ___ are male, age |
|18-25 and not registered, check the box and we will register you. |
|Register Me ________ |
| |
|Q10. Have you ever been convicted for the possession or sale of illegal drugs for an offense that occurred while you were receiving federal student aid? [pic] |
| |Q12. Student’s Enrollment Status |
|Q11. Student’s High School Completion Status |[pic] |
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|[pic] | |
|Section 3: Student Dependency Status |
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|Q13.Were you born before January 1, 1986? |[pic] |
| |[pic] |
|Q14 As of today, are you married? (Answer “Yes” if you are separated but not divorced.) | |
|Q15 At the beginning of the 2009–2010 school year, will you be working on a master’s or doctorate program (such as an MA, MBA, MD, |[pic] |
|JD, PhD, EdD, or graduate certificate, etc.)? | |
|Q16 Are you a veteran of the United States Armed Forces or are you currently serving on active duty in the U.S. Armed Forces for |[pic] |
|purposes other than training? | |
|Q17 Do you have children or other dependents (other than your spouse) who live with you and who receive more than half of their |[pic] |
|support from you, now and through June 30, 2010? | |
|If you (the student) answered “No” to every question in this section, go to Section 4. |
|If you answered “Yes” to any question in this section, skip Section 4 and go to Section 5. |
|Section 4: Parent Demographics - Complete if you (the student) answered “No” to every question in Section 2. |
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|Q18 Mother’s Full Name |
|[pic] [pic] [pic] |
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|Q19 Mother’s Social Security Number |Q20 Mother’s Date of Birth |
|[pic] |[pic] |
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|Q21 Father’s Full Name |
|[pic][pic][pic] |
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|Q22 Father’s Social Security Number |Q23 Father’s Date of Birth |
|[pic] |[pic] |
|Section 5: Income Information – From 2008 IRS Tax Return |
|If you (the student) answered “No” to EVERY question in Section 2, questions refer to your parent(s). |
|If you (the student) answered “Yes” to ANY question in Section 2, questions refer to you (and your spouse). |
|Q24 IRS tax filing status? |[pic] |
|(Tax filing status from IRS Form 1040, 1040A, 1040EZ — Boxes 1 through 5) | |
|Q25 Adjusted Gross Income for 2008? |[pic] |
|(Adjusted Gross Income on IRS Form 1040—line 37; 1040A—line 21; or 1040EZ—line 4) | |
|Q26 Number of IRS Exemptions. |[pic] |
|(Exemptions on IRS Form 1040 Line 6d or on Form 1040A—Line 6d) | |
|Q27 Total amount of excludable income? |[pic] |
|(Excludable income is need based student work, federal work study, grants and scholarships) | |
|Section 6: Colleges to Receive the Results of Your FAFSA Application |
|[pic] |
|Section 7: Student and Parent Signature Statement |
|[pic] |
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