Student Information Worksheet 2017 • Keep for your records Name of Student Social Security Number Part I — Student Status 1 Was this person a student during 2017? 2 What kind of school did the student attend during 2017? (Check all that appl a Elementary c I I College (postsecondary) e b High school (secondary) d Vocational school 3 Did the student receive scholarships or other education assistance? =Yes = No Military academy Not a .cable liable In No Part II — College Student Information 1 Did the student complete the first 4 years of postsecondary education as of 1/1/2017? =Nes Inn" In NA 2 Was this student enrolled at an eligible education institution during 20179 =Yes =No n NA 3 Was this student enrolled in a program that leads to a degree, certificate, or credential? lilies =No n NA 4 Was this student taking courses as part of a postsecondary degree program or to acquire or improve job skills? inYeS In No In NA 5 Did this student take at least one-half the normal full-time workload for one academic period'' inYeS in No In NA 6 Has this student been convicted of a felony for possessing or distributing _ a controlled substance? Fives No NA 7 Is this student an eligible dependent of the taxpayer? I (Yes No NA 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 Part Ill — Education Credit and Deduction Qualifications (Determined based entries in Part II) 1 Is this student qualified for the American Opportunity Credit? Fives F- 1 No 2 Is this student qualified for the Lifetime Learning Credit? ni feS n No 3 Is this student qualified for the Tuition and Fees Deduction? El ves n No Part IV — Educational Institution and Tuition Summary School Name EIN Received 2016 10981 Address (number, street, apt no., city, state, and ZIP Code) with Box 2