2011 - 2012 Untaxed Income Form

Dear Student,
On your 2011-2012 financial aid application, you or your parent(s) reported a non-taxable income from the 2010 tax year. When verifying your application, we were unable to determine exactly what type of untaxed income the above amount was. Please check the appropriate source below and submit this form to the Bellevue University Financial Aid Office as soon as possible.

If you have any questions relative to the completion of this form, please contact the OneStop Service Center at (800) 756-7920 / (402) 293-2000, option 0 or by email at OneStop@bellevue.edu. Thank you for your cooperation and prompt response. This information is required prior to the processing of your financial aid.

Source of 2010 untaxed income

Payments to tax-deferred pensions and savings plans (example: untaxed portions of 401(k) and 403(b) plans). IRA deductions. Veteran's non-educational benefits such as Disability, Death Pension, Dependency and Indemnity Compensation. Housing, food, and living allowances for members of the military (BAH, BAS) or clergy. Cash support from a non-custodial parent or any other person. Child support received. Other

Please define "Other" untaxed income in the above field.

The amount of 2010 untaxed income was reported in error, the correct amount is zero.

Note: The following are not untaxed income: Financial aid, welfare payments, untaxed Social Security benefits, SSI, food stamps, “rollover” pensions, veteran’s educational benefits, and payments received from states for foster care and adoption assistance.

Certification

By signing this worksheet, I (we) certify that all the information reported to qualify for Federal student aid is complete and correct.

Warning: If you purposely give false or misleading information on this worksheet, you may be fined, be sentenced to jail, or both.

Student Name

Student ID Number

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