Military Information Form 0910 by 22AThu


									                                                                                  Financial Aid Office
                                                                                    Student Services

                                                  2009-2010 Military Information Form

__________________________________                        _____________________________
Print: Student’s Last Name, First Name, MI                  SS Number or UH Student ID #

This form is used to verify non-taxable military allowances (Worksheet B on the FAFSA) for an
independent student, the spouse of an independent student or for the parent(s) of a dependent
student who was on active military duty in 2008.

1. The following military information applies to:  ____Student ____Spouse ____Parent
2. What was the 2008 pay grade of the person noted in the question above? _______
3. In the year 2008, did the person noted in the question above live in military housing?
   ____Yes** ____No

Indicate below the annual (12-month total) amount of military benefits the person noted above
received in 2008 for each category. Please do not leave any item blank. Respond with a
dollar amount or zero. If you require assistance in completing the information below, please
utilize your December 2008 Leave-Earning Statement (LES) or contact your military
Paymaster’s Office.


Cost of Living Allowance (COLA)                                          $ ____________
Basic Allowance for Subsistence (BAS)                                    $ ____________

Basic Allowance for Quarters (BAH)                                       $ ____________
** If you answered “Yes” to question #3 above,
  you must still enter the amount you would
  have received if you lived off base.
Clothing Allowance (CMA)                                                 $ ____________
Family Separation Allowance (FSA)                                        $ ____________
Other: ______________________                                            $ ____________

Total Non-Taxable Military Allowance                                     $ ____________
(To be reported on question #41 or #85, Worksheet B of the FAFSA)

I certify that the information provided is true and correct to the best of my knowledge. I
understand that any false statement or misrepresentation may be a cause for denial, reduction,
or repayment of my financial aid.

_______________________________________________                  _______________________
Student’s Signature                                              Date

________________________________________________                 _____________________
Signature of Person Receiving Military Benefits                  Date
(If Student is a Dependent)

                                                                               45-720 Kea‘ahala Road
                                                                             Kane‘ohe, Hawai‘i, 96744
                                                                            Telephone (808) 235-7449
                                                                                   Fax (808) 247-5362

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