KU

ASSET WORKSHEET - PARENT

Student's Name: Student ID/SSN:

In accordance with the Federal Regulations in regards to Requirement 34 CFR 668.53, your FAFSA/ISIR Application has been selected in a process called verification.  The following questions need to be verified against your 2011 Federal Income Tax Return.  These questions may/may not be reported on the FAFSA/ISIR Application or the FAFSA/ISIR shows an unusually low or zero amounts for assets.

Please check/complete which statement applies to you (parent(s)) as of the date the FAFSA was signed.

Taxable interest is reported on my Federal Tax Return and the value of all accounts that generate this interest is
$

Parent(s) Not Applicable
Dividends are reported on my Federal Tax Return and the value of all accounts that generate dividends is
$
Parent(s) Not Applicable
A Capital Gain or Loss is reported on my Federal Tax Return and the value of any assets associated with the Capital Gain or Loss is
$
Parent(s) Not Applicable

The taxpayer whose IRS Tax Form 1040 shows income on Line 12 must complete the following information in order to determine whether or not Net Worth of Business should have been disclosed on the FAFSA.  The HERA excludes the net value of a small business that you own and control and that has 100 or fewer full time or full-time equivalent employees.

Please check ONE of the following statements and sign and date the bottom of this form.
(If none of these statements apply, please provide an explanation below.

I currently own and control a small business with 100 or fewer employees.
I currently do NOT own a business.
I am an independent contractor, or I am otherwise self-employed.
Not Applicable

Explanation:

The taxpayer whose IRS Tax Form 1040 shows income on Line 17 must select one of the following and provide an explanation regarding the nature of the selection:  
S Corporation
Partnership
Rental
Not Applicable

Explanation:

I hereby certify that all information above is true and complete. I have not knowingly or intentionally provided any false statements or fraudulent documentation. I understand that if I am found to have knowingly or intentionally given false or fraudulent statements and/or documentation, eligibility for aid can be jeopardized.

By my signature I attest to having answered the following questions truthfully.

Parent Signature
Name/Electronic Signature By typing your name you have created an electronic signature as legally binding as your handwritten signature.