Brandeis University
2015 Tax Year
Parent Non-Tax Filer’s Statement
This statement should be completed if you are a U.S. citizen, eligible non-citizen, and/or U.S. resident and are
not required to file a 2015 U.S. federal tax return. You must attach copies of any W-2 form(s) and/or 1099
form(s) received in 2015.
List below all of the sources and amounts of money received from January 1, 2015 through December 31,
2015. Include untaxed income (e.g., AFDC, SSI, military living allowance) and earnings not reported on a
federal income tax return. Please include supporting documentation for all income sources listed below.
Parent Information – Please Print
Parent completing this form:
Parent 1
Parent 2
Both Parent 1 and Parent 2
Parent 1’s Name:
Social Security Number:
_
Parent 2’s Name:
Social Security Number:
_
Student Information – Please Print
Student’s Name:
Social Security Number:
2015 Parent Income Information: 1/01/15 – 12/31/15
Source of Income
Amount
$
$
$
$
$
$
$
Total: $
Certification
By signing this form, I certify that I did not and am not required to file a 2015 U.S. federal tax return. In addition,
I certify that all of the information reported on this form is complete and correct.
Parent 1’s Signature:
_ Date:
_
Parent 2’s Signature:
_ Date:
_
To view your IDOC requirements or instructions, go to https://idoc.collegeboard.com.