EOP FINANCIAL AND FAMILY QUESTIONNAIRE

EOP
FINANCIAL AND FAMILY
QUESTIONNAIRE
2015-2016
S TAT E U N I V E R S I T Y O F N E W Y O R K
Educational Opportunity Program
Before any final decision can be made on your admission application to the Educational Opportunity Program, you are
required to submit household information and income documentation so that your economic eligibility for EOP can be determined.
Economic Eligibility:
1. Financial Eligibility Form – You must complete the financial eligibility form (freshmen only).
2. 2
014 FEDERAL INCOME TAX RETURN - Submit a signed copy of your/your parent’s Federal Income Tax Return
(IRS 1040/1040A/1040EZ). Include all schedules and W2 forms.
3. NON-TAXABLE INCOME –Submit documentation of all non-taxable income received in 2014, such as Social Security,
Social Services, and Veterans Benefits. Ask your case worker or an authorized official to complete,sign and stamp Form C
and/or Form D, if applicable.
4.
You must file the 2015-2016 FREE APPLICATION FOR FEDERAL STUDENT AID (FAFSA) and indicate “New Paltz,”
college code #002846, as a school to receive your information.
Remember, no final or “official” admission decision or financial aid will be offered without the materials listed above.
PLEASE PRINT (DO NOT LEAVE ITEMS BLANK)
Student’s Name:______________________________________________________________________________________________
Last Name
First NameM.I.
Permanent Address:___________________________________________________________________________________________
Street Apt. #
__________________________________________________________________________________________
CityStateZip Code
Social Security Number:
Phone Number: (Day) _____________________
(Evening) _________________________
Date of Birth:
___________________________________________________
Date you began living in New York State:
__________________________________________________
Date of High School graduation or G.E.D.
___________________________________________________
Month/ Day /Year
Month/ Day /Year
Month/ Day /Year
Name of High School:__________________________________________________________________________________________
Name of Guidance Counselor / College Advisor: ___________________________________________________________________
Indicate if you are one of the following:
U.S. Veteran (A veteran is a person who has served in the U.S. Armed Forces)
Military Service Member (Active Duty, Reserve, National Guard)
Dependent of a Military Service Member (Dependent is a spouse or child)
1
Have you ever attended another college? yes
no
If yes, name of college:____________________________________________________________________________________
Date of attendance:_______________________________________________________________________________________
Are you a citizen of the United States?
If no, enter Alien Registration Number:
no
____________________________________________
Attach a photocopy of your Resident Alien Card (both sides).
Are you a ward of the state?
yes
yes
no
If yes, complete Section A and skip Section B. Sign the certification on page 4, and return form.
(Attach documentation that you are a ward of state; i.e., court papers, letter from Social Services Agency.)
If you are not a ward of state and do not live with your parents, see the special instructions on the bottom of this page.
SECTION A: Student Information
Check a or b:
a.
Student did or will file a 2014 income tax return.
(Attach a photocopy of student’s 2014 Federal Tax Return, including all schedules and W-2 forms.)
b.
Student will NOT file a 2014 income tax return
Source of income:
Do not leave any blanks. If answer is “0” put in a $0.
Earnings from Work:
$___________________________
Interest Income:
$___________________________
Trust Fund/ Inheritance:
$___________________________
Other:
$___________________________
Student Assets: Report information as of the day you are completing this form.
Cash Checking Account:
$___________________________
Savings:
$___________________________
Investments:
$___________________________
Other:
$___________________________
SPECIAL INSTRUCTIONS FOR STUDENTS WHO DO NOT LIVE WITH THEIR PARENTS:
If you are not a ward of the state and do not live with your parents, you must attach documentation as to why it is necessary for you
to live with someone other than your parents. Documentation can be any legal documents regarding custody or a letter from a social
worker, attorney, or high school guidance counselor. Please note that even if you do not live with either parent you may still be required
to provide their income information for Financial Aid purposes. It is advised that you collect their tax returns and submit them if at all
possible.
-Please DO NOT leave items blank-
2
SECTION B: Parent Information
*For questions on who is considered a parent, view the FAFSA website at:
www.fafsa.ed.gov/help/ffdef07.htm
Check a or b:
a.
Parents did or will file a 2014 income tax return.
Attach a photocopy of the signed 2014 Federal tax return, including all schedules and W-2 forms.
b.
Parents will NOT file a 2014 income tax return.
Income: Tax filers and non-taxfilers must answer the following for the year 2014.
Do not leave blank. If answer is “0”, put in a $0.
Submit documentation for ALL
income received in 2014
Father’s earnings:
$___________________________
Mother’s earnings:
$___________________________
Social Security:
$___________________________ Complete form C, if social security is received
Social Services:
$___________________________ Complete form D, if social services benefits are received
Interest income:
$___________________________
Dividends:
$___________________________
Child Support:
$___________________________ Trust Funds/Inheritance:
$___________________________
Other:
Include money received for all children in household.
$___________________________
Assets: Taxfilers and non-taxfilers must answer asset questions.
Report information as of the day you are completing this form.
Cash, checking accounts:
$___________________________
Savings: $____________________________
Investments:
$____________________________
$____________________________ Parents monthly:
Do parents own a home?
yes
no
If yes, year of purchase:
____________________________ Do parents own other real estate?
yes
no
If yes, market value? Do parents own a business?
$____________________________ yes
rent paidor
mortgage payments
Purchase price: $_______________________________
Debt: $______________________________________
no
If yes, What type of business?______________________________________________________________________________
Value of the business:
$___________________________
Debt on the business: $___________________________
-Please DO NOT leave items blank-
3
SECTION C: Household Information
PLEASE DO NOT LEAVE ANY QUESTIONS BLANK IN THIS SECTION.
1. The current marital status of the parent you live with is:
married to biological parent
married to step-parent
Year remarried__________________________________
divorced/separated from biological parent
Year of divorce__________________________________ divorced/separated from step-parent
Year of separation_______________________________
widowed from biological parent
Year parent widowed ____________________________
never married*
*If you checked never married, what is the last date your parents lived in the same household? ______________________
*P
lease give information about both biological parents UNLESS the parent you live with has remarried. In that
case, give information for that parent and step-parent.
A. Father’s Name:_______________________________________ Father
Stepfather
Legal Guardian
Address:_______________________________________________________________________________________________
Occupation:_________________________________________ Employer:_______________________________________
B. Mother’s Name:______________________________________ Mother
Stepmother
Legal Guardian
Address:_______________________________________________________________________________________________
Occupation:_________________________________________ Employer: _______________________________________
Is there an agreement between natural parents specifying a contribution for the student’s education? yes
no
2. Give information for ALL FAMILY MEMBERS who reside in your household:
FULL NAME
AGE
RELATIONSHIP
COLLEGE NAME (IF ATTENDING)
Before signing the certification, review your application. Do not leave any blanks. Make sure all required documents are attached. File will NOT be reviewed until all supporting documentation is received.
CERTIFICATION: I swear that all information reported on this form is correct. I understand that any deliberate falsification or
omission of information may result in denial of admission, dismissal from the college or legal action.
Student’s Signature_____________________________________________________Date__________________________________
_
Parent’s Signature______________________________________________________Date___________________________________
Please return this form to:
Educational Opportunity Program
SUNY New Paltz
1 Hawk Drive, New Paltz, New York 12561-2443
4
Form C
SOCIAL SECURITY VERIFICATION
2015-2016
S TAT E U N I V E R S I T Y O F N E W Y O R K
Educational Opportunity Program
Submit ONLY IF benefits were received in 2014
Financial Aid Applicant: Your Federal Financial Aid application requires you to provide verification of your Social Security benefits.
Please submit form 1099 for 2014 for all household members receiving benefits or complete the following form:
1. Complete Sections I, II, and III.
2.Take this form to your Social Security Office - they will complete the section marked “For Social Security Use Only” on the back
of this form.
3. When completed, return this form to the Educational Opportunity Program at the State University of New York at New Paltz.
SECTION I
Student’s Name ________________________________________________ Last
First
Address
_____________________________________________
_____________________________________________
Social Security Number
StreetApt.
_________________
CityState
Zip
SECTION II: Release of information
If you were a dependent student during 2014, this release statement must be signed by you and your parent (s). If you were an
independent student during 2014, this release statement must be signed by you (and your spouse, if you are married).
“I give the Social Security Administration the authority to disclose to SUNY New Paltz the amount of 2014 Social Security
benefits paid for myself and my minor children as listed in Section III following.”
________________________________________________
Student’s Signature
________________________________________________ Spouse’s Signature
Social Security Number
________________________________________________ Mother’s Signature
Social Security Number
________________________________________________ Father’s Signature
Social Security Number
(over)
SECTION III
Please list parents, student, and
all family members under age 19.
For Social Security Use only:
Total amount paid during 2014 for each person listed
1._____________________________________________ _______________________________________________
2._____________________________________________ _______________________________________________
3._____________________________________________ _______________________________________________
4._____________________________________________ _______________________________________________
5._____________________________________________ _______________________________________________
6._____________________________________________ _______________________________________________
7._____________________________________________ _______________________________________________
8._____________________________________________ _______________________________________________
_______________________________________________
Signature and Title of Authorized Social Security Official
Agency Stamp
_______________________________________________
Address of District Office
______________________________________________
_______________________________________________
Telephone Number
Date
Your Financial Aid cannot be processed until this form (if applicable) and any other requested documentation
is completed and returned to:
Educational Opportunity Program
SUNY New Paltz
1 Hawk Drive
New Paltz, New York 12561-2443
Form D
SOCIAL SERVICES VERIFICATION
2015-2016
S TAT E U N I V E R S I T Y O F N E W Y O R K
Educational Opportunity Program
Submit ONLY IF benefits were received in 2014
CASE NUMBER___________________
TO: Social Services Department
The following student:___________________________________________________________________________________
Student Social Security Number:
Case Name: _________________________________________________________________________________________ ___
Address: _____________________________________________________________
Street
Apt. Social Security for case name
_____________________________________________________________
City State
Zip Code
. . . is applying for financial aid at New Paltz and has indicated that his/her family received Social Services assistance during 2014.
We would appreciate your help in establishing financial need according to the applicant’s income and assets by providing the
following information for that year:
1. Type of Assistance:_______________________________________________________________________________________
2. Amount of Assistance: $_________________________________ OR $__________________________________________
(monthly)(yearly)
3. How many members are there in the household?_____________
4. Please indicate any other sources of income this household may be receiving:_______________________________________
_______________________________________________________________________________________________________
Thank you for your cooperation.
If you have any questions, please call the Financial Aid Office at (845) 257-3250
___________________________________________
(Date)
PLEASE RETURN TO:
Educational Opportunity Program
SUNY New Paltz
1 Hawk Drive
New Paltz, New York 12561-2443
____________________________________________________________
(Signature of Caseworker)
____________________________________________________________
(Agency Stamp)
S TAT E U N I V E R S I T Y O F N E W Y O R K
Office of Financial Aid
What type of financial aid is available to accepted EOP Freshmen?
SAMPLE NEW PALTZ EOP FRESHMAN FINANCIAL AID PACKAGE *
SUNY New Paltz is committed to offering EOP Freshmen a first-year financial aid package that provides
grant aid to cover the majority of a student’s billed expenses.
Below is an estimated sample of the financial aid package for 2015-2016.
YEAR’S BILLED EXPENSES
YEAR’S AID
Tuition . . . . . . . . . . . . . . . . . $6,170.
Fees ** . . . . . . . . . . . . . . . . . $1,235.
Room . . . . . . . . . . . . . . . . . . $7,220.
Meal Plan . . . . . . . . . . . . . . $3,676.
PELL Grant . . . . . . . . . . . . . . . . $5,730.
TAP Grant . . . . . . . . . . . . . . . . . . $5,165.
SUNY Tuition Credit . . . . . . . . $1,030.
EOP Grant . . . . . . . . . . . . . . . . . $2,100.
Other Grants . . . . . . . . . . . . . . . . $800.
TOTAL . . . . . . . . . . . . $18,301.
TOTAL Grant Aid . . . . . . $14,825.
Subsidized Loan . . . . . . . . . . . . $3,500.
TOTAL AID . . . . . . . . . . . $18,325.
OPTIONAL FINANCIAL AID
(for books, transportation and personal expenses)
Federal College Work Study . . . . . . . . . . . $1,300.00
Unsubsidized Loan . . . . . . . . . . . . . . . . . . . . $2,000.00
* The largest share of available grant aid is issued to EOP students in their first year of college. In their following years of college,
most EOP students will receive grants to cover approximately 70% of billed expenses with the remainder covered by Direct
Subsidized and Direct Unsubsidized Loans.
** Conditional
Health Insurance Fee $1,855
(Health insurance fee is optional if you are already covered under a family health insurance plan.)
DISCLAIMER: Cost and Aid are subject to change at any time due to changes in state and federal regulations.
Office of Financial Aid
SUNY New Paltz
200 Hawk Drive
New Paltz, New York 12561-2437
845-257-3250 • 845-257-3568 fax • www.newpaltz.edu/financialaid

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