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An income verification statement for students participating in the trio student support services program at the university of arkansas, little rock. The statement is used for independent and dependent students to certify their taxable/nontaxable income for the purpose of determining eligibility for the program. The trio student support services program is a federally funded initiative by the u.s. Department of education.
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2801 S. University Ave., Little Rock, AR 72204 (501) 569-683-
I, __________________________________, do hereby certify, that after exemptions and deductions, my taxable/nontaxable income for the year ______________ is ___________________. Number in Family/Household____________________.
Student Signature Date The TRIO Student Support Services Program is 100% federally funded by the U. S. Department of Education. Revised 4/
2801 S. University Ave., Little Rock, AR 72204 (501) 569-683-
I, __________________________________, do hereby certify, that after exemptions and deductions, my taxable/nontaxable income for the year ______________ is ___________________. Number in Family/Household____________________.
Parent/Guardian Signature Date
Student Signature Date The TRIO Student Support Services Program is 100% federally funded by the U. S. Department of Education. Revised 4/