NONRESIDENT ALIEN STUDENT EXCESS SCHOLARSHIP CREDIT

TAX STATUS DETERMINATION

TO BE COMPLETED BY STUDENT RECEIVABLES YEAR 2002

Name: _________________________________________ Term (check one)

Tax ID#: _________________________________________ ___ Spring

___ Interim

___ Summer I

Country: _____________________________Visa: _______ ___ Summer II

___ Fall

Credit Applied to Account: ______________________

Less Qualified Amounts Under IRC § 117

Tuition: _________________

Required Fees: _________________

Book Allowance: _________________

Total Qualified Amount (_____________________)

Excess Credit (Nonqualified Amount) ______________________

Previous Tax Withholding this Term ______________________

___________________________________ ________________

Signature Date

TO BE COMPLETED BY NRA TAX ACCOUNTANT

Is there a tax treaty in effect with the student’s country of tax residence? YES NO

Does the treaty contain an exemption for scholarships/fellowships? YES NO

Has the student completed IRS Form W8-BEN? YES NO

If “YES” to all, Scholarship is treaty exempt. NO WITHHOLDING REQUIRED.

If “NO” to any, TREATY EXEMPTION IS NOT APPLICABLE; calculate necessary withholding as follows:

Excess Credit (From Above) _______________________

Less Personal Exemption Allow. (______________________)

Is student also receiving payments through Payroll? YES NO

If “YES”, no personal exemption allowance can be taken here, since daily allowance is given through Payroll. If “NO”, give allowance as follows:

Spring 3000 / 365 x 122 days $1003

Interim 3000 / 365 x 31 days $254

Summer I 3000 / 365 x 45 days $370

Summer II 3000 / 365 x 45 days $370

Fall 3000 / 365 x 122 days $1003

Taxable Amount _________________________

Tax Rate x 14%

Tax Liability _____________________

Less Previous Tax Withholding (from above) (________________________)

TAX WITHHOLDING REQUIRED _________________________

___ NO WITHHOLDING REQUIRED

___ WITHHOLD $_____________ VIA CHARGE TO STUDENT’S ACCOUNT

___ REVERSE FEDERAL TAX W/H IN THE AMOUNT OF $_______________

________________________________________________ ___________________

NRA Tax Accountant Date