2018-2019APPLICATIONFOR
AIDFORPART-TIMESTUDY(APTS)
Submitcompletedapplicationandtaxreturn(s)to:
•PLEASE NOTE! •
SUNYADIRONDACK
640 Bay Road • Queensbury, NewYork 12804
—PleasePrint—
You must submitALLREQUIRED2016 NYSTAXRETURNS(signed)withthisapplication.
1. Social Security Number--2. Date of Birth (use numbers only)
3.YourName
4.YourAddress
last namefirstnamemiddle initial
numberstreet(apt. #)
city or townstatezip
5.AreyoualegalresidentofNewYorkState?(Seeinstructionsonpage1.)qYesqNo
6.Checkthe box that applies to you (See instructionson page 2.):
1 / qIamaUnitedStatesCitizen / 3 / qIamaparoledrefugee,refugee,orconditionalentrant2 / qIamapermanentresidentalien / 4 / qIamnoneoftheabove
7.Maritalstatus(Checkonlyonebox.):1qUnmarried(single,divorcedorwidowed)2qMarried3qSeparated
8.Ifmarried,enterthedateyouweremarried.Ifseparated/divorcedorwidowed,giveearliestdateonwhichyouwere
separated/divorcedorwidowed:month
year
9.Haveyougraduated,orwillyougraduatefromhighschool;orhaveyoureceivedorwillyoureceiveaGED?
qYesqNo
10.HaveyoureceivedNewYorkStateTAP,APTSorStateScholarshipsinpreviousyears?qYesqNo
IfYES, howmanyyearsdidyoureceivepayments?Enterthemostrecentyearyoureceivedgrants.
11.HaveyoureceivedthemaximumnumberofTAPorAPTSPayments?qYesqNo
12.Willallorpartofyourtuitionchargesbepaidorreimbursedbyanemployer?qYesqNoIfYES,enteramountifknown.Fall2018$ Spring2019$
APPLICANT/SPOUSE (IFMARRIED) INCOMESTATEMENT -ALLAPPLICANTS MUSTANSWER QUESTIONS13 and14
13. Didyou (the applicant)and your spouse file a2016 tax return?(Check one box.):
qNo—DIDNOTFILEanytaxreturn
qYes—FILEDANYSTAXRETURN-Enterincomeintheappropriateboxesbelow:
qYes—FILEDAFEDERALRETURNONLY
FORM1040Enterthetotalexemptionsfromline6dandincomefromline37.FORM1040AEnterthetotalexemptionsfromline6dandincomefromline21.FORM1040EZ Enter“0”forexemptionsandincomefromline4.
14.Wereyoueligibletobeclaimedorwereyouclaimedasadependentonyourparents’NewYorkStateorfederaltaxreturnfor
2016.
qYes—Ifyes,YOUMUSTREPORTPARENTALINCOMEbelow.
q No —If no,read andsign theaffirmation onthe bottomof thispageand ifmarried, yourspouse mustalso sign
andenterSocialSecuritynumber.Ifyouhavedependentsofyourownotherthanaspouse,checkthisbox.
15.EXCLUSIONOFPARENTALINCOME—Reportinquestion16theincomeofaparentwithwhomyoulivedmostin
2016orwhohadcustodyorwouldhavehadcustody,ifyouwereaminor.
TOEXCLUDETHEINCOMEOFYOUR
Toexclude
1.qFATHERdied
FATHER (stepfather,adoptivefather)ORMOTHER(stepmother,adoptivemother),
FATHER’Sincome
2.qseparatedordivorced
3.qparentsnevermarried
monthyear
givethereasonbycheckingtheappropriate
Toexclude
1.qMOTHERdied
box.Enterthedateofdeathorseparation/
divorceandentertheamountsofsupport
MOTHER’Sincome
2.qseparatedordivorced
3.qparentsnevermarried
monthyear
receivedifseparated/divorced.
Onlyoneparent’sincomecanbeexcludedforseparation/divorce.
Supportamount-entertheamountofsupportreceivedforYOUduring2016fromtheparentwhoseincomeistobeexcluded.Ifnone,enterzero.
16.Did applicant’s FATHER (stepfather, adoptive father) or MOTHER (stepmother, adoptive mother) file a2016 income tax
return?(Checkonebox.):qNo—DIDNOTFILEanytaxreturn
qYes—FILEDANYSTAXRETURN-Enterinappropriateboxesbelow:
qYes—FILEDAFEDERALRETURNONLY
FORM 1040Enterthetotalexemptionsfromline6d
andincomefromline37.
FORM 1040AEnterthetotalexemptionsfromline6d
andincomefromline21.
FORM1040EZ Enter“0”forexemptionsandincome
fromline4.
17.ALLPERSONSWHOSEINCOMESARELISTEDINQUESTIONS13and16mustread andsigntheaffirmation.AFFIRMATION:Iherebycertifythatalltheinformationprovidedbymeuponthisapplicationisaccurateandcomplete.Thisinformationwillbeacceptedforallpurposesastheequivalentofanaffidavitand,ifitcontainsafalsestatement,shallsubjectmetothesame penaltiesforperjuryasifIhadbeendulysworn.IauthorizetheschooltoreleasetoNYSHigherEducationServicesCorporation (NYSHESC)anyinformationrequestedpertinenttothisapplication.IconsenttotheverificationbyNYSHESCofanystatementmade hereinandauthorizetheNYSDepartmentofTaxationandFinancetoreleasetoNYSHESCcertifiedcopiesofmypersonalincometax returnsfor2016.IconsenttothereleasebyNYSHESCofsuchinformationasmaybeprovidedbylaworregulationinthecourseof financialaidprogramadministration.
Student’sSignatureDate
Student’sSpouse’sSignatureDate
Father’sSignatureDate
Mother’sSignatureDate
Spouse’sSocialSecurityNumber
Father’sSocialSecurityNumberMother’sSocialSecurityNumber
First3lettersofFather’slastname
First3lettersofMother’slastname
NYS’sPROGRAMOF
2018-2019
AID FOR PART-TIME STUDY (APTS)
INSTRUCTIONS:PREPARINGANAPPLICATIONFORAPTS
TheAPTSprogramisagrantprogramfinancedbyNYSinconjunctionwithparticipatingeducationalinstitutionsthroughout the state. These instructions may be updated at a later date due to changes in legislation.
A)StudentEligibilityatSUNYAdirondack
TobeeligibleforAPTSatSUNYAdirondackin2018-2019
astudentmust:
•BealegalresidentofNewYorkStateforatleastoneyearpriortothestartoftheterm.
•BeaU.S.citizenoreligiblenon-citizen.
•Have2016family(studentandspouse,orparent)NewYorknettaxableincomethatdoesnotexceed$50,500.
•HavenotexhaustedeligibilityunderNewYork’sTuitionAssistanceProgram(TAP).
limited-fundsprogramsoallstudentsareencouragedtoapplyasearlyaspossiblebeforefundsareexpended.APTSisawarded duringthefallandspringsemesters,butnotduringthesummeror winterterms.
C)RecipientSelectionandAwardDetermination
StudentswhomeetbothSectionA’seligibilityrequirementsandSection B’s application requirements will receiveAPTS accordingtothefollowingschedule:
EnrollmentatEndofThirdWeek*
•HaveaGPAofatleast2.0atSUNYAdirondackifacontinuing
Half-Time(6,7or8credits)
$500
orreturningstudent.
•Beenrolledinadegreeorcertificateprograminwhichyouhave
notalreadyearnedadiploma.
•Beenrolled for at least sixbut less than twelve creditspersemester incoursesforwhich youhavenotpreviously receivedapassinggradeandwhicharerequiredforyourSUNYAdirondackdegreeorcertificate.
•BeingoodacademicstandingasdefinedintheSUNYAdirondack
Catalog.
•Notbeindefaultonastudentloan.
B)StudentApplicationProcedure
Each student must file a2018-2019 FreeApplication for Federal StudentAid (FAFSA) and submit all requested documentation to the SUNYAdirondack FinancialAid Office. In addition,
studentsmustsubmitthefollowingdocumentsdirectlytotheSUNYAdirondack FinancialAid Office.
1)anAPTSapplication
2)2016 NewYorkState tax return(s)
Only one application per academic year is required.This is a
Three-QuarterTime(9,10or11 credits)$1,000
•Every effort will be made to notify the recipient of the awardamountpriortotheduedateoftheterm’stuitionbill,inwhichcasetheawardwillbemadeintheformofatuitiondeferment.
•If the award is made after the tuition has been paid, SUNY Adirondackwillrefundthetuitiontothestudentapproximatelyeightweeksafterthestartoftheterm.
•Recipients who are no longer enrolled in at least six credits at the end of the bill adjustment period will have their awards rescinded.
•RecipientsmustmeettheSatisfactoryAcademicProgressandPursuitofProgramrequirementsasdefinedintheFinancialAidSectionoftheSUNYAdirondackCatalogtobeeligibleforsubse-quentpaymentsofAPTSorotherNYSprograms,suchasTAP.
•ReceivingAPTS for one term uses one-half of one term’s
eligibilityforNYSprograms.
*OnlycreditsrequiredforaSUNYAdirondackdegreeorcertificateareconsideredforfundingunderthisprogram.Awardamountsaresubjecttoadjustmentifthetuitionliabilityhasbeenadjustedtolessthanthestandardaward.
1-4.SOCIALSECURITYNUMBER,DATEOFBIRTH,NAME,ADDRESS.Enteralltheinformationrequested.
5.NEWYORKSTATERESIDENT.
•CheckYES if any of the following apply to you:
-you now reside in NewYork StateAND will be an undergraduateAND you lived in NewYork State for the last 2
termsofhighschool,or
-you were a resident when you entered military service,Vista or Peace CorpsAND re-established NewYork Stateresidency within 6 months after release from service, or
-youhaveresidedinNewYorkStateforat least12monthsimmediately precedingthefirsttermfor whichyouareseeking aidAND have established domicile (permanent residence) in NewYork State.
•Check NO if:
-youarefinanciallydependentonyourparentsandneitherofthemisaNewYorkStateresident,or
-your parents are separated or divorced and the parent with whom you are living is not a NewYork State resident, or
-youresideinNewYorkStateforthesolepurposeofattendingcollege,or
-none of the above conditions apply to you.
6.UNITEDSTATESCITIZENSHIPORALTERNATE REQUIREMENTS.Checktheboxthatappliestoyou.Youmustcheckoneofthefourboxes.Proofofyourstatusmayberequired.
7-8. MARITALSTATUS.Check thebox thatapplies toyou. If youwere marriedas ofDecember 31,2016 you mustreportincome information for your spouse in question 13. Enter the month and year you were married or, if separated/divorced or wid-owed, give earliest date on which you were separated/divorced or widowed.If you are other than SINGLE, enter your spouse’sSocialSecurityNumberinitem17.
9.HIGH SCHOOLGRADUATION.CheckYES ifyouhavegraduatedorwill graduatefromhighschoolor ifyoureceivedorwillreceiveaGEDcertificate.
10.PRIORNEWYORKSTATEFINANCIALASSISTANCE.
•CheckYES if you have received payment under any of the following award programs, and give the number of years you re-ceived such payment:
TuitionAssistance Program (TAP)
Child of Deceased Officer-Firefighter-
Aid for Part-Time Study Program (APTS)CorrectionOfficerAwardProgram
Part-TimeTAP
ADA-EligibleTAP
Regents College Scholarship Program
Regents Nursing Scholarship Program
Child ofVeteranAward Program
WorldTradeCenterMemorialScholarships
VietnamVeteransTuitionAward Program
Persian GulfVeteransTuitionAward
Empire State Challenger’s Scholarship Program
Empire State Scholarship of Excellence
Paul DouglasTeacher Scholarships
•Check NO if you have never received payment under the programs listed above.
11.MAXIMUMPAYMENT.Youareeligibletoreceivefinancialassistanceas an undergraduate fromNewYorkStatefor upto4years(8semestersortheequivalent).Communitycollegestudentsarecappedat6semesters(the7thand8thpaymentcan only be paid at a four-year school.This eligibility is extended to 5 years if your academic program normally takes 5 years tocomplete,orifyouareenrolledinaprogramorremedialstudyunderthefollowingprograms:
*HEOP- Higher Education Opportunity Program*SEEK - Search for Education, Elevation and Knowledge
*EOP- Educational Opportunity Program*CD - College Discovery
Whenyouhaveexhaustedeligibilityfor financialassistanceasan undergraduate, anoticeissentadvising thatyouhavereceived
themaximumnumberofpaymentsforwhichyouareeligible.
•CheckYES if you have received the maximum number of payments or such a notice.
•Otherwise, check NO.
12.EMPLOYERREIMBURSEMENT.Awardsunderthisprogramarelimitedbytheactualtuitionpaidbythestudent.
Inconsideringastudentforanaward,theinstitutionmusttakeintoaccountothersourcesoffinancialaidavailable.
•CheckYES if your employeror the Veteran Administrationhas paid, or will reimburse, all or part of your tuition for the term(s)forwhichthisapplicationforAPTSismade,andenteramountofreimbursement,ifknown.
•Otherwise, check NO.
13.APPLICANT/SPOUSE INCOME.Youand,ifmarried,yourspousemustcompletequestion13,evenifyouhadnotaxableincome in 2015. If you were claimed as a dependent by your parents (including stepparents or adoptive parents) on their 2015taxreturn, you are also required to provide their income in question 16.
REPORTING INCOMEINFORMATION
•Check NO if you did not file any state or federal income tax return for2016.
If a person required to report income did not file a 2015income tax return, the obligation to report that person’s income remains.Ifyou,your spouse,or yourparents didnot filea taxreturn butwererequired todo so,check “NO”in question(s)13 and/or16 andenterthetotalincome andtotalexemptionsthat youwouldhavebeen requiredtoreporthadyoufiledataxreturn.
•CheckYESifyouFILEDANEWYORKSTATETAXRETURNFOR2016andgivethefollowinginformationintheappropriate
area.
NYSFORMIT-201If a NYS Form IT-201 was filed, enter the number ofdependentexemptions which you enteredon Line 36 of the NYS IT-201; enter NYS taxable income from Line 37.
•CheckYESifafederalreturnwasfiledbutaNewYorkStatereturnwasnot.
IfForm1040Enter exemptions from Line 6d and adjusted gross income from Line 37.IfForm1040AEnter exemptions from Line 6d and adjusted gross income from Line 21.IfForm 1040EZ Enter “0" for exemptions and adjusted gross incomefrom Line 4.
14.WEREYOU CLAIMEDASATAX DEPENDENT?
•CheckYES and report parental income on page 2 of the application if you were claimed as a dependent on your parents’
2016taxreturn.
•CheckNOandsigntheaffirmation onpage2oftheapplication ifyouwerenoteligibleto beclaimedasadependent byyour parents. (If married, your spouse must also sign the application.) If you have checked “NO” but have dependents of your
ownotherthanyourspouse,alsocheckthesecondboxasindicated.
NOTE: If you werenot claimed asa tax dependenton your parents’2016 tax return,you must still reportparental income inquestion 16 if you could have been claimed but were not.The criteria for determining whether or not you could have been claimed are detailed in the instructional booklet forfiling state and federal tax returns. Generally, you were eligible to be claimed as adependentif:
•you were single, and
•your parent or parents provided more than one-half of your support in2016, and
•your gross income was less the $4,000. If your income was more than $4,000, you could still have been claimed if you were
under19yearsofageoryouwereunder24yearsofageandafull-timestudent.
15.EXCLUSIONOFPARENTS’INCOME.Reportinquestion16theincomeoftheparentwithwhomyoulivedmostin2016or who had custody of would have had custody if you were a minor.The income of a parent can be excluded in the cases of death, divorce or separation which occurred before December 31,2016.You should check the appropriate box in question 15 and enter the date and amount of support received on your behalf.The income of a parent can also be excluded if your parents never married (can only exclude one parent). In this case use your date of birth as the exclusion date and enter amount of support received on yourbehalf.
16.PARENTS’INCOME.The instructionsforReporting IncomeInformationare thesame asappearin question13.Report thefollowing incomes: father’s (stepfather’s, adoptive father’s)2016 income and mother’s (stepmother’s, adoptive mother’s)2016income. If you excluded the income of one parent in question 15, report the income of the other parent in question 16. In addition, enter Social Security Numbers as appropriate in theAFFIRMATION Section.
17.AFFIRMATION.You MUSTsignthe application. Inaddition, if youare married, yourspouse must signand give his/herSocial Security Number. If your parents were required to provide income information in question 16, they must sign and give theirSocialSecurityNumbersandthefirstthreelettersoftheirlastname.
In signing thisAFFIRMATION you are acknowledging that you have read, understood and accepted the conditions described in theAFFIRMATION appearing on the application form.
WORKSHEETFORESTIMATING
NEWYORKSTATENET TAXABLE INCOME
SECTIONI
Applicant/SpouseorParents’Incomes
Read carefully and check the appropriate box(es) (A, B, or C) and determine the net taxable income according to the
instructionsbelow:
If a 2016 NYS Form IT-201 was filed,use the income from Line 37 on your tax return and determine the net taxable
incomebyusingthefollowingmethod:
a.Ifsingle,ormarriedfiling ajointreturn,usethe incomeonLine37as thenettaxableincome.
EnterApplicant/Spousenettaxableincomeinquestion13andParents’nettaxableincomeinquestion16.
b.Ifmarriedandfiling separatereturns,addtheincomes onLine37for bothreturnstoobtain nettaxableincome.
EnterApplicant/Spousenettaxableincomeinquestion13andParents’nettaxableincomeinquestion16.
Ifyoudidnotfileanystatetaxreturnandyoudidfileafederaltaxreturn,usetheexemptionsandincomesfromthe linesdescribedbelowdependingonwhattypeoffederaltaxreturnyoufiled:
2016FederalTaxReturn / Exemptions / Income1040 / Line 6d / Line 37
1040A / Line 6d / Line 21
1040EZ / Enter “0” / Line 4
Usingtheexemptionsandincomesfromthetaxreturn youfiled,calculatethenettaxableincomeusing the methods described in Section II.
SECTIONII(IfyoucheckedCinSECTIONIabove)NYSNetTaxableIncomeCalculationWorksheet / Applicant/Spouse / Parents
a. Income from Section I / a..00 / a..00
b. Number of exemptions (see SECTION I) times $1,000.
(Besureto subtract“1”if singleor “2”ifmarried, sincepersonalexemptionsarenotallowedfortaxpayerand/orspouse.) / b..00 / b..00
c. Subtract Line “b” from Line “a” / c..00 / c..00
d.StandardDeduction:
—If you are a single dependent filer, enter $3,100on Line “d”
——If you are a single taxpayer, enter $7,800 on Line “d” —
—If you are head of household, enter $10,950 on Line “d” ——If you are a married taxpayer, enter $15,650 on Line “d” — / d..00 / d..00
e. Net taxable income — subtract Line “d” from Line “c” / e..00 / e..00
EnterApplicant/Spousenettaxableincomeonquestion13andParents’nettaxableincomeinquestion16.
NEWYORKSTATE
HIGHEREDUCATIONSERVICESCORPORATION