PARENT NON-FILER FORM

2014-2015
PARENT NON-FILER FORM
This form should be completed if your parent(s) is not required to file an income tax return for the 2013 calendar year. Please
attach any W-2 Form(s) received for wages earned in 2013.
Tax returns include 2013 U.S. IRS Forms 1040, 1040A, 1040EZ, tax returns from Puerto Rico, or other foreign income tax returns.
Name of AMS Student:
Banner ID:
Class Year:
I/We, the parent(s) of the student listed above will not file a 2013 tax return for the following reasons:
I/We, the parent(s) of the student listed above earned the following income in 2013.
Earnings/Income in 2013:
Source of Earnings/Income in 2013:
Name of Parent (please print):
Signature:
Date:
If you are married, your spouse must sign below:
Name of Parent (please print):
Signature:
Please return this form along with attached documentation to:
Alpert Medical School
Office of Financial Aid
Box G-M123
Providence, RI 02912-9706
Date:
email: [email protected]
phone: 401-863-1142
fax: 401-863-5113