EFTA01222460.pdf

Student Information Worksheet 2018 • Keep for your records Name of Student Social Security Number Part I — Student Status 1 Was this person a student during 2018? =Yes = No 2 What kind of school did the student attend during 2018? (Check all that appl a Elementary c Li College (postsecondary) e Military academy b High school (secondary) d Vocational school Not a cable . 3 Did the student receive scholarships or other education assistance? 'Yes in No Part II — College Student Information 1 Did the student complete the first 4 years of postsecondary education as of 1/1/2018? =yes Inn" In NA 2 Was this student enrolled at an eligible education institution during 20189 lilies =No n NA 3 Was this student enrolled in a program that leads to a degree, certificate, or credential? nett =No n NA 4 Was this student taking courses as part of a postsecondary degree program or to acquire or improve job skills'? inYeS In No In NA 5 Did this student take at least one-half the normal full-time workload for one academic period? inYeS in tle In NA 6 Has this student been convicted of a felony for possessing or distributing _ a controlled substance? Yes No NA 7 Is this student an eligible dependent of the taxpayer? ri ves No NA 8 In how many prior years has an American Opportunity Credit been claimed for this student? . . . 9 In how many prior years has a Hope Credit been claimed for this student Part III — Education Credit and Deduction Qualifications (Determined based entries in Part II) 1 Is this student qualified for the American Opportunity Credit? Fives F- 1 No 2 Is this student qualified for the Lifetime Learning Credit? ni feS n No 3 Is this student qualified for the Tuition and Fees Deduction? F —Iyas I-- I No Part IV — Educational Institution and Tuition Summary Received 2017 10981 with Box 2 filled and box 7 checked? —8 Address Tuition Scholar- On School Name (number, street, apt no., paid ships Form EIN city, state, and ZIP Code) or grants 1098-T Ye Ye- No No If a foreign address: foreign province/state: Postal code: Country: Yet _I Yes_ I I Non No If a foreign address: foreign province/state: Postal code: Country: Totals Are all School Employer Identifification Numbers (EIN) known? (School EIN's must be entered in the program to claim the American Opportunity Credit) eves In No EFTA01222460  Page 2 Part V — Education Assistance (Scholarships, Fellowships, Grants, etc.) Total Taxable Tax-free 1 Educational assistance that is always tax-free: a Veteran or employer assistance from Form 1098-T Worksheets . b Other veteran assistance or certain Indian tribal payments c Other tax-free employer-provided assistance d Total 2 Scholarships, fellowships, and grants not reported on Form W-2: a Scholarships and grants from Pad IV above b Other scholarships, fellowships and grants c Total 3 Scholarship reported in 2018 not allocable to 2018 expense 4 Amount required to be used for other than qualified education expenses 5 Subtract line 3 and 4 from line 2c 6 Total qualified education expenses from Part VI below 7 If student is a candidate for a degree, enter the amount used for qualified education expenses, otherwise, enter -0-. 8 Subtract line 7 from line 5 9 Taxable part. Add lines 4 and 8 10 Tax-free educational assistance. Add tines 1d and 7 Part VI - Education Expenses Description Total Amount eligible for American Lifetime Tuition Qualified Qualified Qualified Qualified Oppor- Learning and Fees Higher Higher Higher Elementary tunity Credit Deduct• Education Education Education and Credit ion Expense Expense Expense Secondary for for for Expense 529 Plan ESA US for ESA Bonds and QTP Expenses: 1 Tuition paid from Part IV and qualified elementary and secondary tuition Paid to institution as a condition of enrollment: 2 Fees 3 Books. supplies. equipment Paid to other than institution or not a condition of enrollment: 4 Books. supplies. equipment 5 Other course•relatetl . . 6 Room and board 7 Special needs expenses . 8 Computer expenses . . . 9 QTP or ESA contribution 10 Academic tutoring 11 Uniforms 12 Transportation 13 Total qualified expenses . Adjustments: 14 Refunds 15 Tax-free assistance . . . 16 Deducted on Sched A . . 17 Used for credit or deduction =I 18 Used for exclusion See tax help 19 Total adjustments. 20 Adjusted qualified expenses EFTA01222461  Page 3 Part VII — Education Credit or Deduction Election 1 Elect credit or deduction which results in best tax outcome 2 Elect the American Opportunity Credit 3 Elect the Lifetime Learning Credit 4 Elect the tuition and fees deduction 5 Not applicable Part VIII — Qualified Tuition Program (Section 529 Plan) For Purposes For Purposes of of 10% Regular Additional Tax Tax 1 Enter the total distributions from this QTP during 2018 2 Enter the amount of adjusted qualified education expenses attributable to this OTP: a Qualified Elementary and Secondary Education Expenses b Qualified Elementary and Secondary Education Expenses applied C Adjusted Qualified Higher Education Expenses d Adjusted Qualified Higher Education Expenses applied 3 Total qualified eduction expenses attributable to this OTP 4 Excess distributions. Subtract line 3 from line 1. If line 4 is greater than zero, complete lines 5 through 8. 5 Total distributed earnings from Form 1099-O box 2 6 Fraction. Divide line 3 by line 1. 7 Multiply line 5 by line 6 8 Earnings taxable to recipient. Subtract line 7 from line 5. Part IX — Education Savings Account (ESA) For Purposes For Purposes of of 10% Regular Additional Tax Tax 1 Total Education Savings Account (ESA) distributions from Form 1099-Q. . 2 Qualified Elementary and Secondary Education Expenses 3 Qualified Elementary and Secondary Education Expenses applied 4 Subtract line 3 from line 1. 5 Adjusted Qualified Higher Education Expenses 6 Qualified Higher Education Expenses applied to ESA distributions 7 Excess distributions. Subtract line 6 from line 4. 8 Distributions taxable to recipient Part X — Series EE and I U.S. Savings Bonds Issued After 1989 1 Total proceeds from U.S. Savings Bonds cashed during 2018 for this student 2 Adjusted Qualified Higher Education Expenses 3 Qualified Higher Education Expenses applied to exclusion of U.S. bond interest 4 Interest included in line 1 5 Name and address of eligible educational institution(s) attended: Institution Name Institution Name Street address Street address City State Zip Code City State Zip Code EFTA01222462