Verification of Untaxed Income Form

Wheaton College Student Financial Services
Verification of Untaxed Income Form
for Dependent Students

Certain sections of this worksheet must be completed by the student, and certain sections must be completed by the student's parent. The student will complete his/her section of the worksheet first. Once the student has completed his/her section and clicked to Submit, an email will be sent to the student's parent with a link to complete the parent section.

Please indicate which section you are completing:*

I am the student applicant completing the student sectionI am the parent of the student applicant completing the parent section

Aid year for which this form has been requested*

Student Applicant's Name*

First NameLast Name

Student Applicant's Wheaton College ID Number*

Please fill in all boxes. If the answer to an item is zero, please enter "0".

Untaxed Income Worksheet*

	Parent(s)	Student
1. Payments (direct or withheld from earnings) to tax-deferred pension and retirement savings plans (e.g., 401k or 403b plans), including, but not limited to, amounts reported on W-2 forms in Boxes 12a through 12d with codes D, E, F, G, H and S. Don't include amounts reported in code DD (employer contributions toward employee health benefits).
2. Actual amount of any child support received for the children in your household. Do not include foster care payments, adoption payments, or any amount that was court-ordered but not actually paid. (This question only applies to the parent(s). Please enter zero in the Student box.)
3. Housing, food and other living expenses paid to members of the military, clergy and others. Include cash payments and/or the cash value of benefits received. Do not include the value of on-base military housing or the value of a basic military allowance for housing.
4. Veterans non-education benefits received. Include Disability, Death Pension, Dependency and Indemnity Compensation (DIC) and/or VA Educational Work-Study allowances. Do not include federal veterans educational benefits such as: Montgomery GI Bill, Dependents Education Assistance Program, VEAP Benefits, Post-9/11 GI Bill. (This question only applies to the parent(s). Please enter zero in the Student box.)
5. Other untaxed income not reported and not excluded elsewhere on this form. Include untaxed income such as workers' compensation, disability, Black Lung Benefits, untaxed portions of health savings accounts from IRS Form 1040 Line 25, Railroad Retirement Benefits, etc. Do not include any items reported or excluded above. In addition, do not include extended foster care benefits, student aid, Earned Income Credit, Additional Child Tax Credit, Temporary Assistance to Needy Families (TANF), untaxed Social Security benefits, Supplemental Security Income (SSI), Workforce Innovation and Opportunity Act (WIOA) educational benefits, on-base military housing or a military housing allowance, combat pay, benefits from flexible spending arrangements (e.g., cafeteria plans), foreign income exclusion, or credit for federal tax on special fuels.
6. [This question applies only to the student. Please enter zero in the Parent(s) box.] List any money received or paid on the student’s behalf (e.g., payment of student’s bills) and not reported elsewhere on this form. Enter the total amount of cash support the student received. Include support from a parent whose information was not reported on the student’s FAFSA, but do not include support from a parent whose information was reported. For example, if someone is paying rent, utility bills, etc., for the student or gives cash, gift cards, etc., include the amount of that person's contributions unless the person is the student’s parent whose information is reported on the student’s FAFSA. Amounts paid on the student’s behalf also include any distributions to the student from a 529 plan owned by someone other than the student or the student’s parent, such as grandparents, aunts, and uncles of the student.

Parent Total

Student Total

Parent Question 5

Student Question 5

Question 6

Please enter the type(s) of income reported as Parent(s) Other Income in Question 5.

Please enter the type(s) of income reported as Student Other Income in Question 5.

Please give a detailed explanation of the money received or paid on the student's behalf as reported in Question 6.

	Amount per Month (U.S. dollars)	How did you pay for this? Please be specific: "Used wages", "Paid by business", "Took money from savings", "Borrowed a loan", "Used funds received from child support/alimony", "Received gift from a friend", "Used state assistance", etc.
Rent/Mortgage (include property taxes and home owners' insurance)
Utilities (heat, electricity, water, phone, cell phone, cable, internet, etc.)
Food (do not include food stamps)
Transportation (gas, car payment/insurance, maintenance, commuter expenses, etc.)
Insurance (medical, life, etc.)
Loan payments, credit card payments, etc.
Vacation/Entertainment/Recreation
Gifts/tithes/contributions
Other expenses