Financial Aid & Educational Financing

OCOLUMBIA UNIVERSITY
IN THE CITY OF NEW YORK
Columbia College &Columbia Engineering
Office Location: 618 Alfred Lerner Hall
Phone: 212-854-3711
Website: http://cc-seas. financlalald.columbia.edu/
Upload to |DOC or email to
2021 Student Tax Non-Filer Certification Form
ugrad-finaid@columbia.edu

Student Name: Wardaan Grover ID #: Cp04722265

Please Note: Students should complete this form only if NOoT FILING a2021 federal income tax return.
Instructions:
FILLABLE form: First save this form to your computer, then type your answers, re-save, print and sign. Please confirm that
your data has been included before submitting.
Icertify that Idid not, willnot and am not required to file a 2021 federal income tax return. (Please refer to IRS Guidelines
to confirm Tax Filing Requirements: https://www.irs.gov/help/ita/do-i-need-to-file-a-tax-return. US Citizens and US
Permanent Residents who are claimed as a dependent on another taxpaver's federal tax return must file their own federal
tax return if earned income exceeds $12,550.)
Indicate source(s) of student income in 2021; do not report any income received by the parent on the student's behalf.
DO NOT LEAVE ANYTHING BLANK. WRITE IN "$O.00" OR "N/A" WHERE APPROPRIATE.
(O)$0 Student Income: Iconfirm that I earned/received no income for 2021

(the student) earned/received income for 2021 (detailed below).

Contributions
Income from work (Federal Work-Study earnings): sO Attach a W-2 form.
toward Retirement:
W-2Box 12 (Code
Income from work (non-Work Study earnings): Attach a W-2 form, if available. D,E,F,G, H, or S)

Social Security Attach Form 1099.

Public Assistance Do not include food stamps or subsidized housing.

Veteran's Affairs Benefits

Untaxed Interest Income Attach a year-end statement from your bank showing the interest received in 2021.

Untaxed Pension Benefits

s0
Other untaxed income

(please explain: support from relatives, disability benefits, etc. )

TOTAL 2021 INCOME
so.00
SPECIAL CIRCUMSTANCES/EXPLANATIONS:

I(we) certify that | (we) did not and will not file a 2021 federal income tax return. The income information listed above is accurate
and complete.
SIGNATURE OF STUDENT DATE o2/17/2023