Financial Aid & Educational Financing

Columbia College & Columbia Engineering

Office Location: 618 Alfred Lerner Hall
Phone: 212-854-3711
Website: http://cc-seas.financialaid.columbia.edu/
Upload to IDOC or email to
2021 Student Tax Non-Filer Certification Form ugrad-finaid@columbia.edu

Student Name: ID #: C

Please Note: Students should complete this form only if NOT FILING a 2021 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.
• I certify that I did not, will not 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 taxpayer’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 “$0.00” OR “N/A” WHERE APPROPRIATE.

$0 Student Income: I confirm that I earned/received no income for 2021

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

Contributions
Income from work (Federal Work-Study earnings): $ Attach a W-2 form.
toward Retirement:
W-2 Box 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 $

Other untaxed income $

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

TOTAL 2021 INCOME $ 0.00
SPECIAL CIRCUMSTANCES/EXPLANATIONS:

I (we) certify that I (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