2012-2013 Student Aid Report Correction Form
Name ___________________________________________ Social Security # ________________________________
*DRN #:__________________________________________ *Date of Birth: ________________________________
Corrections from Information Acknowledgement 2012-2013 Student Aid Report
Only write corrections for the Information Acknowledgement on this paper. The word "parent" indicates parental
information. Give this form directly to your Robert Morris University Admissions Counselor or Financial Aid Advisor.
CORRECTIONS
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LAST NAME
FIRST NAME
MIDDLE NAME
PERMANENT ADDRESS W/ APT#
CITY
STATE ABBREVIATION
ZIP CODE
SOCIAL SECURITY NUMBER
DATE OF BIRTH
PERMANENT TELEPHONE #
DRIVER'S LICENSE NUMBER
DRIVER'S LICENSE STATE ABBREVIATION
E-MAIL ADDRESS
CITIZENSHIP STATUS
ALIEN REGISTRATION NUMBER
MARITAL STATUS
DATE OF MARITAL STATUS
STATE OF LEGAL RESIDENCE
LEGAL RESIDENT OF THIS STATE BEFORE JANUARY 1 , 2007
IF NOT, GIVE MONTH & YEAR YOU BECAME A LEGAL RESIDENT
ARE YOU MALE OR FEMALE
REGISTER FOR SELECTIVE SERVICE?
DRUG CONVICTION AFFECTING AID?
YES/NO
FATHERS EDUCATIONAL LEVEL
MOTHERS EDUCATIONAL LEVEL
HIGH SCHOOL COMPLETION STATUS DIPLOMA / GED / HOME SCHOOL
NAME OF HIGH SCHOOL AND CITY AND STATE WHERE IT IS LOCATED
FIRST BACHELOR'S DEGREE BEFORE JULY 1, 2012
GRADE LEVEL IN COLLEGE IN 2012-2013
DEGREE YOU WILL BE WORKING ON IN 2012-2013
INTERESTED IN WORKSTUDY YES/NO
DID YOU FILE AN INCOME TAX RETURN FOR 2011?
YES/NO
WHAT INCOME TAX RETURN DID/WILL YOU FILE IN 2011? 1040, 1040A, OR 1040EZ
IF YOU FILED 1040 WERE YOU ELIGIBLE TO FILE 1040A OR 1040EZ? YES/NO
WHAT WAS YOUR (AND SPOUSES) ADJUSTED GROSS INCOME FOR 2011?
TOTAL AMOUNT OF YOUR (AND SPOUSES) INCOME TAX FOR 2011?
YOUR (AND SPOUSES) EXEMPTIONS FOR 2011?
HOW MUCH DID YOU EARN FROM WORKING IN 2011?
HOW MUCH DID YOUR SPOUSE EARN FROM WORKING IN 2011?
CURRENT TOTAL BALANCE OF CASH, SAVINGS, AND CHECKING ACCOUNTS
CURRENT NET WORTH OF INVESTMENTS
CURRENT NET WORTH OF BUSINESS/INVESTMENTS FARMS?
EDUCATION CREDITS RECEIVED IN 2011
CHILD SUPPORT PAID BECAUSE OF DIVORCE OR SEPARATION
TAXABLE EARNINGS FROM NEED-BASED EMPLOYMENT PROGRAMS IN 2011
STUDENT GRANT AND SCHOLARSHIPS AID REPORTED TO IRS IN YOUR AGI IN 2011
COMBAT PAY OR SPECIAL COMBAT PAY
CO-OP EARNINGS
TAX DEFERRED PENSIONS/SAVINGS FROM W-2 BOX 12a-12d
IRA DEDUCTIONS AND PAYMENTS
CHILD SUPPORT RECEIVED FOR ALL CHILDREN
TAX EXEMPT INTEREST INCOME
UNTAXED PORTIONS OF IRA DISTRIBUTIONS
UNTAXED PORTIONS OF PENSIONS
HOUSING, FOOD AND OTHER LIVING ALLOWANCES PAID TO MILITARY, CLERGY, & OTHERS
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VETERENS NONEDUCATION BENEFITS
OTHER UNTAXED INCOME (WORK COMP, DISABILITY,home buyer credit)
MONEY RECEIVED OR PAID ON YOUR BEHALF
WERE YOU BORN BEFORE JAN 1, 1989
ARE YOU MARRIED?
ENROLLED IN MASTERS OR DOCTORATE IN 2012-2013
CURRENTLY SERVING ON ACTIVE DUTY IN THE U.S. ARMED FORCES?
ARE YOU A U.S. VETEREN OF THE U.S ARMED FORCES?
DO YOU HAVE CHILDREN YOU SUPPORT?
DEPENDENTS OTHER THAN CHILDREN/SPOUSE?
SINCE AGE 13, ARE BOTH PARENTS DECEASED, IN FOSTER CARE OR WARD OF COURT?
ARE YOU OR WERE YOU AN EMANCIPATED MINOR?
ARE YOU OR WERE YOU IN LEGAL GUARDIANSHIP?
DID A HIGH SCHOOL LIASON DETERMINE YOU WERE HOMELESS AS OF 7/1/2011
DETERMINED TO BE HOMELES BY HOUSING AND URBAN DEVELOPMENT AS OF 7/1/2011
AT RISK OF BEING HOMELESS
PARENTS MARITAL STATUS MARRIED, DIVORCED/SEPARATED,WIDOWED OR SINGLE
MONTH AND YEAR PARENTS WERE MARRIED, SEPARATED/DIVORCED OR WIDOWED
FATHER'S/STEPFATHER'S SOCIAL SECURITY NUMBER
FATHER'S/STEPFATHER'S LAST NAME
FATHER'S/STEPFATHER'S FIRST INITIAL
FATHER'S/STEPFATHER'S DATE OF BIRTH
MOTHER'S/STEPMOTHER'S SOCIAL SECURITY NUMBER
MOTHER'S/STEPMOTHER'S LAST NAME
MOTHER'S/STEPMOTHER'S FIRST INITIAL
MOTHER'S/STEPMOTHER'S DATE OF BIRTH
PARENTS EMAIL ADDRESS
PARENTS STATE OF LEGAL RESIDENCE
LEGAL RESIDENT OF THIS STATE BEFORE JANUARY 1 , 2007
IF NO, GIVE MONTH AND YEAR BECAME LEGAL RESIDENT
HOW MANY PEOPLE ARE IN YOUR PARENT'S HOUSEHOLD?
HOW MANY WILL BE COLLEGE STUDENTS DURING 7/1/2012 AND 6/30/2013
RECEIVED SUPPLEMENTAL SECURITY INCOME
YES/NO
RECEIVED FOOD STAMPS
YES/NO
RECEIVED FREE OR REDUCED LUNCH
YES/NO
RECEIVED TANF BENEFITS
YES/NO
RECEIVED WIC BENEFITS
YES/NO
HAVE PARENTS COMPLETED 2011 TAX FORMS?
YES/NO
WHAT INCOME TAX RETURN DID/WILL YOUR PARENT FILE IN 2011? 1040, 1040A OR 1040EZ
IF PARENTS FILED 1040, WERE THEY ELIGIBLE TO FILE 1040A OR 1040EZ? YES/NO
AS OF TODAY IS EITHER PARENT A DISLOCATED WORKER? YES/NO
PARENTS' ADJUSTED GROSS INCOME FOR 2011
PARENTS' INCOME TAX FOR 2011
PARENTS' EXEMPTIONS FOR 2011
HOW MUCH DID FATHER/STEPFATHER EARN FROM WORKING IN 2011?
HOW MUCH DID MOTHER/STEPMOTHER EARN FROM WORKING IN 2011?
PARENTS' CURRENT TOTAL OF CASH,SAVINGS, AND CHECKING
PARENTS' NET WORTH OF INVESTMENTS
PARENTS' NET WORTH OF BUSINESS OR INVESTMENT FARMS
EDUCATION CREDITS RECEIVED IN 2011
CHILD SUPPORT PAID BECAUSE OF DIVORCE OR SEPARATION
PARENTS TAXABLE EARNINGS FROM NEED-BASED EMPLOYMENT
STUDENT GRANT AND SCHOLARSHIP AID REPORTED TO IRS IN 2011 AGI
COMBAT PAY OR SPECIAL COMBAT PAY
CO-OP EARNINGS
TAX DEFERRED PENSIONS/SAVINGS FROM W-2 BOX 12a-12d
IRA DEDUCTIONS AND PAYMENTS
CHILD SUPPORT RECEIVED FOR ALL CHILDREN IN 2011
TAX EXEMPT INTEREST INCOME
UNTAXED PORTIONS OF IRA DISTRIBUTIONS
UNTAXED PORTIONS OF PENSIONS
HOUSING, FOOD AND OTHER LIVING ALLOWANCES PAID TO MILITARY, CLERGY, & OTHERS
VETERENS NONEDUCATION BENEFITS
OTHER UNTAXED INCOME NOT REPORTED (WORK COMP, DISABILITY)
HOW MANY PEOPLE ARE IN YOUR HOUSEHOLD?
HOW MANY PEOPLE IN YOUR HOUSEHOLD WILL BE IN COLLEGE 7/1/2012-2013
RECEIVED SUPPLEMENTAL SECURITY INCOME
YES/NO
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RECEIVED FOOD STAMPS
YES/NO
RECEIVED FREE OR REDUCED LUNCH
YES/NO
RECEIVED TANF BENEFITS
YES/NO
RECEIVED WIC BENEFITS
YES/NO
AS OF TODAY ARE YOU (OR SPOUSE) A DISLOCATED WORKER? YES/NO
NAME OF COLLEGE
HOUSING PLANS
NAME OF COLLEGE
HOUSING PLANS
NAME OF COLLEGE
HOUSING PLANS
NAME OF COLLEGE
HOUSING PLANS
DATE THIS FORM WAS COMPLETED
STUDENT SIGNATURE
PARENT SIGNATURE
104 PREPARER'S SOCIAL SECURITY NUMBER
105 EMPLOYER ID NUMBER
106 PREPARER'S SIGNATURE AND DATE
You must read this Certification and sign below. PLEASE DO NOT PRINT.
CERTIFICATION
All of the information on this form is true and complete to the best of my knowledge.
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STUDENT
DATE
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FATHER/ STEPFATHER
DATE
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MOTHER/ STEPMOTHER
DATE
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