<p> 2009 ASU Dependent Tuition Waiver Eligibility Questionnaire Use for Spring 2009, Summer 2009, Fall 2009, and Winter 2009 Waivers</p><p>Employee ASU ID #</p><p>Student Name ______Birth Date______</p><p>The purpose of this questionnaire is to clarify dependent eligibility. The student must be eligible to be claimed as the employee’s dependent for federal income tax purposes on IRS form 1040 or 1040A in order to claim the ASU tuition waiver. For additional information regarding dependent rules, please see IRS Publication 17, “Your Federal Income Tax”, pages 26 through 34, at http://www.irs.gov/pub/irs- pdf/p17.pdf.</p><p>Did you claim the referenced student as a dependent on your 2008 federal income tax return? Yes ______No ______If No, could you claim the referenced student as a dependent, except for a divorce decree or other exemption sharing arrangement? [For purposes of the tuition waiver, a dependent child of divorced parents is treated as the dependent of both parents.] Yes ______No ______</p><p>Do you expect to claim the referenced student as a dependent on your 2009 federal income tax return? Yes ______No ______</p><p>Did the referenced student file a joint income tax return in 2008? Yes ______No ______</p><p>Do you expect the referenced student will file a joint income tax return in 2009? Yes ______No ______</p><p>There are two paths to meeting dependent eligibility: “Qualifying Child” OR “Qualifying Relative.” </p><p>To meet dependent eligibility under “Qualifying Child” tests, the child must have “lived” with you for more than half the year. Except for temporary absences such as being away from home for college, did the referenced student live with you for more than half the year in 2008? Yes ______No ______</p><p>Except for temporary absences, such as being away from home for college, do you expect the referenced student to live with you for more than half the year in 2009? Yes ______No ______</p><p>To meet dependent eligibility under “Qualifying Relative” tests, you must provide over half of the total support for the referenced student. Total support includes amounts paid for food, housing, clothing, education, medical and dental care, transportation, recreation and similar necessities. Did you provide over half of total support for the referenced student in 2008? Yes ______No ______</p><p>Do you expect to provide over half of total support for the student in 2009? Yes ______No ______</p><p>For students born on or before December 31, 1984, did the student have gross income less than $3500 in 2008? Yes ______No ______</p><p>For students born on or before December 31, 1985, do you expect the student to have gross income of less than $3500 in 2009? Yes ______No ______Sworn Statement</p><p>Under penalties of perjury, I declare that to the best of my knowledge and belief, the statements above are true, correct, and complete. </p><p>______Employee Signature Date</p><p>For additional information about dependent eligibility , please see IRS Publication 501, “Exemptions, Standard Deductions, and Filing Information at http://www.irs.gov/pub/irs-pdf/p501.pdf.</p>