REDUCED INCOME FORM
2016-2017
STUDENT’S LEGAL NAME______________________________________________________
STUDENT I.D. NUMBER____________________________________DATE________________
To be completed by student/spouse, or parent that expects a substantial change in income from 2015 to 2016.
Typically, we start reviewing these forms in August, in the order received, as other processing commitments
allow. We cannot guarantee that all forms will be reviewed prior to the start of the academic year.
NOTE: Adjustments in financial aid due to changes in farm and/or business income will not be considered
until after 2016 federal tax returns are available to verify this often unpredictable income.
Complete all steps. Submit directly to the Financial Aid Office at UW-Green Bay with documentation as noted.
1) If you have not already done so, submit a copy of your 2015 Tax Return Transcript. YOU MUST OBTAIN THIS
FORM DIRECTLY FROM THE IRS. To request a Tax Return Transcript from the IRS for tax year 2015, contact
the IRS at 1-800-908-9946 or www.irs.gov/Individuals/Get-Transcript. As an alternative, you may use the IRS
Data Retrieval Tool on the FAFSA to validate the income information submitted on the FAFSA. Failure to provide
this information will result in a delay of processing.
2) Provide an explanation of income changes (i.e. why is your income changing?), or attach a separate letter of
explanation of the changes:
3) Provide a Summary of Anticipated 2016 Income for household members (provide calculations on the back):
ANTICIPATED INCOME FROM 1/1/2016 TO 12/31/2016
PARENT 1
Wages, salaries, tips (including severance pay, disability
payments and any other income from work)
Other taxable income (unemployment compensation,
interest/dividend income, etc.) List type of income on the
back of this form.
Child support received
Other untaxed income (payments to tax deferred
pension/savings plans, workers compensation, etc.) List type
of income on the back of this form.
TOTAL ANTICIPATED INCOME for 2016
over
PARENT 2
STUDENT
SPOUSE
Student ID #__________________
4) Show us how you determined 2016 estimated income for each household member:
Person (a) is, Name
, relationship to student
.
Gross Year to Date wages/salary/tips per pay stub(s). Covers 1/1/2016 to ___________ =
Anticipated wages/salary/tips. Covers ____________________ to 12/31/2016.
$ _______ per (circle one) week/month x _____number of (circle one) weeks/months =
$_____________
$_____________
Unemployment Compensation $_______per week x ____number of weeks received in 2016 = $_____________
Person (b) is, Name
, relationship to student
.
Gross Year to Date wages/salary/tips per pay stub(s). Covers 1/1/2016 to ____________ =
Anticipated wages/salary/tips. Covers ____________________ to 12/31/2016.
$ _______ per (circle one) week/month x _____number of (circle one) weeks/months =
$_____________
$_____________
Unemployment Compensation $_______per week x ____number of weeks received in 2016 = $_____________
Person (c) is, Name
, relationship to student
.
Gross Year to Date wages/salary/tips per pay stub(s). Covers 1/1/2016 to ____________ =
Anticipated wages/salary/tips. Covers____________________ to 12/31/2016.
$ _______ per (circle one) week/month x _______number of (circle one) weeks/months =
$_____________
$_____________
Unemployment Compensation $_______per week x ____number of weeks received in 2016 = $_____________
Other Income Sources (list types, amounts and person receiving income) _______________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
5) Provide documentation to support your explanation for income change. This could include a letter of severance
(showing last day of work) from prior employer, copy of death certificate, copy of legal documents showing end to
child support, etc. depending on your circumstances.
6) Provide documentation to support estimate of income for 2016. This may include unemployment compensation
statement, copies of pay stubs (last one from each job worked in 2016), and/or copies of other income/benefit
statements as applicable.
7) LEGAL SIGNATURES (of student and others completing this form). The income noted on this form is
estimated to the best of my/our ability.
Student________________________________________ Spouse______________________________________
Parent 1_________________________________ Parent 2_______________________________
Parent Email Address________________________________________________________________________
Return this form and documents to:
If you have any questions:
University of Wisconsin Green Bay
Financial Aid Office
2420 Nicolet Drive, SS1100
Green Bay, WI 54311-7001
Call: 920-465-2075
Fax: 920-465-2299
Do not e-mail documents with social security numbers.