TTY: 301-314-7017 (For the Hearing Impaired) s1

15SASSET

OFFICE OF STUDENT FINANCIAL AID FAXTEL0102: Lee 301-405-9265301-314-9000 Building & 301-314-9587888-313-2404 www.financialaid.umd.eduTTYCollege: 301-314-7017 Park, Maryland (for 20742-5145 the hearing impaired) 2015-2016 Student Asset Form

Student Name: ______UID:______

The Office of Student Financial Aid has completed an initial review of your Free Application for Federal Student Aid (FAFSA). Additional information is needed because you or your spouse (if applicable) reported no asset information or there is a discrepancy.

Please complete and return this form to the Office of Student Financial Aid DO NOT LEAVE BLANK

WORTH AS OF THE DAY ASSET DEBT OWED YOU FILED YOUR FAFSA

Cash, Savings & Checking (Not Financial Aid) $

Other Real Estate & Investments Include: real estate, rental property (includes a unit within a family home that has its own entrance, kitchen, and bath rented to someone other than a $ $ family member), trust funds, UGMA and UTMA accounts, money market funds, mutual funds, certificate of deposit, stocks, stock options, bonds, other securities, installment and land sale contracts, commodities etc. Do not include: your primary residence, IRAs, 401Ks, pensions, retirement investments, annuities, cars, boats, or luxury appliances.

Business and Investment Farm $ $ Include: the market value of land, buildings, machinery, equipment, inventory, etc. Do not include: the farm you live on or the value of small business with less than 100 full time employees.

By signing this form, I/we certify all information reported on this form and within the enclosed documentation is complete and correct. I understand that providing false or misleading information may result in a $20,000 fine, a prison sentence, or both, according to the Higher Education Act of 1965, as amended, Section 490(a). Any false or misleading information is subject to cancellation of all financial assistance.

Student’s Signature: ______Date:______

Spouse’s Signature: ______Date:______