Student Information Worksheet 2014 • Keep for your records Name of Student Social Security Number Part I — Student Status 1 Was this person a student during 2014? nYes n No 2 What kind of school did the student attend during 2014? (Check all that appl a H Elementary cH College (postsecondary) e Military academy b High school (secondary) d Vocational school f Not applicable 3 Did he student receive scholarships or other education assistance? Li Yes l= No Part II — College Student Information 1 Did the student complete the first 4 years of postsecondary education as of 1/1/2014? 2 Was this student enrolled at an eligible education institution during 2014? 3 Was this student enrolled in a program that leads to a degree, certificate, or credential? 4 Was this student taking courses as pan of a postsecondary degree program or to acquire or improve job skills? 5 Did this student take at least one-half the normal full-time workload for one academic period? 6 Has this student been convicted of a felony for possessing or distributing a controlled substance? Yes 7 Is this student an eligible dependent of the taxpayer? Yes 8 In how many prior years has an American Opportunity Credit been claimed for this student? 9 In how many prior years has a Hope Credit been claimed for this student =Yes =No =Ives =No 0 =Yes 0 No 0 =Yes 0No Oves Ow 0 H H No No H NA NA NA NA NA NA NA Part III — Education Credit and Deduction Qualifications (Determined based entries in Part II) 1 2 3 Is this student qualified for the American Opportunity Credit? =Yes QYes nYeS n No n No n No Is this student qualified for the Lifetime Learning Credit? Is this student qualified for the Tuition and Fees Deduction? Part IV — Educational Institution and Tuition Summary School Name EIN Received 2013 10987 Address (number, street, apt no., city, state, and ZIP Code) with Box 2 filled Tuition paid and box Schola