VERSep Inc
VERSep Inc
VERSep Inc
This form should be used for an applicant or applicant’s parent (in the case of a dependent student) who filed a
joint return for the year 2009 but is now widowed, divorced, or separated. You must use the joint return to
factor out the individual income and taxes paid.
Read the instructions below BEFORE completing this form. Attach a copy of your signed joint Federal tax return if you
have not yet submitted one to the University of Phoenix. To assist you with completing the Separation of Income Form,
we are providing you with the specific line references for the 2009 US Tax Returns.
Instructions
Starting with the income figures from your W-2(s), add in any income from the joint return which represents your
personal income. Any other income or interest earned should be assessed at 50%, to include business or farm gains or
losses. Also, if the AGI listed on your joint return was adjusted (“Adjustments to Income”), you should reduce the AGI
by the portion of the adjustment that applies solely to you. For example, if an adjustment was made for moving
expenses, which applies to you and your spouse, only 50% of the adjusted amount can be applied against your income.
If you do not assess these items at 50%, you must provide the appropriate tax documents to support your assessment
amounts.
Once you have determined your AGI, establish what percentage of the joint AGI was credited to you, and assess the
joint tax paid by that same percentage.
Example: Your AGI was $35,000. The AGI on the joint tax return was $58,000. The tax paid on the joint return was
$3,000. Divide the $35,000 by $58,000. This gives you a figure of .6034 or 60.3%. Multiply the $3,000 by 60.3%.
Your portion of tax paid equals $1,809.
Your AGI/joint AGI = % of income
Total joint tax X % of income = Your tax
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2010-2011 Verification of Separation of Income
Each item above should be assessed at 50% or higher. If you do not assess these items at 50% or higher (as an income
or adjustment item that did not apply to you in part or in total), you must provide the appropriate tax documents to
support your assessment amounts.
I affirm that the above figures accurately reflect my 2009 Adjusted Gross Income (AGI). I have attached copies of my
W-2 form(s) (or signed statement) and our signed joint tax return used in reporting my 2009 earnings on this form. I
understand that if I do not correctly separate my income and adjustments to income items, or do not provide supporting
documents, it may cause delays in processing the financial aid file. I also affirm and authorize the University of Phoenix
to make any necessary corrections to the income figures in accordance with Federal regulations.
_______________________________________________ _________________________________________
Student’s Signature (Independent Students Only) Last 4 digits of SSN
_______________________________________________ __________________________________________
Parent Name (Print) (Dependent Student Only) Parent Signature (Dependent Student Only)