College of DuPage Office of Student Financial Assistance Last Name: First Name: _ _______________ 2016‐2017 Student/Spouse Non‐Filer Status Statement Student ID: If you or your spouse (if married) did not and were not required to file a 2015 Federal Income Tax Return, please complete the following information and return this form to the Office of Student Financial Assistance. Section A: I (check the appropriate box) Student did not work in 2015 Spouse did not work in 2015 Section B: List wages earned in the United States or in a foreign country in 2015, attach all copies of 2015 W2 and/or 1099 Forms. If wages are earned in a foreign country, please convert to US dollars. Student Employer 2015 Income Spouse Employer 2015 Income $ $ $ $ $ $ $ $ SECTION C: NON‐FILER CERTIFICATION STATEMENT I (check the appropriate box) Student Spouse will not and am not required to file a 2015 Federal U.S. Income Tax Return 1040, 1040A, or 1040EZ. NOTE: The Office of Student Financial Assistance may request a Non Filing Status Information Letter from the Internal Revenue Service (IRS) as further verification of Non Filing Status. Additionally, if based on the amount of income you are required to file a 2015 Federal Tax Return, you will need to file a 2015 Tax Return. For more information on who is required to file a Federal Tax Return, please refer to the IRS Filing Requirements. I have attached a copy of my 2015 W2 and/or 1099 form(s) I was employed in a foreign country and have attached a copy of my 2015 foreign income stated on official company letterhead. (See back page for additional information on foreign income) CERTIFICATION: I/WE certify that all information on this form is true, complete and accurate. Upon request I agree to provide additional proof of the information reported on this form. Warning: If you purposely give false or misleading information, you may be fined up to $20,000, sent to prison, or both. Student Signature Date Spouse Signature (if non‐filer) Date Please return this form to: College of DuPage, Office of Student Financial Assistance – SSC 2220 425 Fawell Blvd., Glen Ellyn, IL 60137 FAX (630) 942‐2151 EMAIL: financialaid@cod.edu The college will not discriminate in its programs and activities on the basis of race, color, religion, creed, national origin, sex, age, ancestry, marital status, sexual orientation, arrest record, military status or unfavorable military discharge, citizenship status, physical or mental handicap or disability (Board Policy 5010; 20‐5).
2016‐2017 Student/Spouse Non Filer Status Statement 03/01/16 Foreign Income Please provide us a wage statement in English. Please also convert all monetary units to U.S. dollars, using the published exchange rate in effect for the day you completed your original FAFSA. (A wage statement is the equivalent of a W2 Form). If there is no statement, please provide a statement of earnings from you and/or your spouse’s employer on their company letterhead in English. If you or your spouse filed a foreign tax return, you and/or your spouse must submit a signed copy of the tax return translated in English and in US dollar amounts based on the exchange rate the day the FAFSA was filed. You and/or your spouse must also write in the exchange rate as of the date you signed the FAFSA. Please identify the following items on the translated foreign tax return by circling the amounts for:  Adjusted Gross Income – This is the total income plus interest and dividend income minus housing allowances and minus contributions to retirement accounts. (Housing allowances and contributions to retirement accounts are reported separately on the FAFSA.)  Income taxes paid  Wages earned