2013-2014 Non Tax Filers Form

Federal Student Aid Programs

Cayuga Community College

Financial Aid Office * 197 Franklin Street, Auburn, NY  13021 * FAX 315-252-2185

                        Auburn Office – 315-255-1743 ext. 2470  *  Fulton Office 315-592-4143 ext. 3004

Please complete the following form.  Once you have entered the necessary information online, you will need to print the form, provide all required signatures and return it to the CCC Financial Aid Office.  Additional information may be requested.

You indicated on your FAFSA that you and/or your parents did not file and are not required to file a U.S. Income Tax Return.  You must complete this form and return to the Financial Aid Office with all necessary attachments.

1.     You are required to attach copies of all W-2 forms that you received from employers.


2.     If you have income from work that was not reported to you on a W-2 you must complete the following:

Student/Spouse Source of Earned Income                        Amount Earned                     Reason for no W-2










Parent Source of Earned Income               Amount Earned                     Reason for no W-2










If you and/or your parent will not file and are not required to file a 2012 Federal Income Tax Return check below:

The Student (and, if married, the student’s spouse) was not employed and had no income earned from work in 2012.

            The parent(s) was not employed and had no income earned from work in 2012.

I certify that the above information is true and complete.  I understand that failure to accurately report income may jeopardize my eligibility for Financial Aid.  I also understand that the U.S. Secretary of Education has the authority to verify information reported on the FAFSA with the Internal Revenue Service and other federal agencies.  I understand that giving false or misleading information may lead to fines up to $20,000, prison, or both.

Student Name___________________________________________________________________________________________


Student Signature_____________________________________________________________            Date_____________________

Dependent Students

Parent Signature______________________________________________________________            Date_____________________

Return this form to the Financial Aid Office at Cayuga Community College