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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