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Financial Aid & Scholarships


Student/Spouse Means of Support and Other Untaxed Income Verification





The income reported by you and your spouse, if married on the 2017-2018 financial aid application appears to be insufficient to support your household. To verify your means of support, answer all of the questions in the three sections below and do not leave any of the questions blank. Provide the annual amount for each item below received in 2015.

Section One

Benefits Received

Name of Person(s) Who Received Benefits -
ENTER N/A IF NOT APPLICABLE

Medicaid

Supplemental Security Income (SSI)

Supplemental Nutrition Assistance Program (SNAP)

Special Supplemental Nutrition Program for Women, Infants and Children (WIC)

Temporary Assistance for Needy Families (TANF)

Free or Reduced Price School Lunch

 

Section Two

Money received or paid on your and your spouse’s (if married) behalf

Amount

List any money received or paid on your behalf by someone else.  Enter the total amount of cash support you and your spouse (if married) received in 2015.  Include only the support received from a parent whose information was not reported on your 2017-2018 Financial Aid Application.  If someone is paying rent or utility bills, for you and your spouse, if married, or gives you cash, or gift cards; include the amount of that person's contributions.  Also includes distributions to you (the student beneficiary) from a 529 plan that is owned by someone other than you or your parents (such as your grandparents, aunts, uncles, and non-custodial parents).

$

 

Section Three

Additional Information: So that we can fully understand your family’s financial situation, please provide the amounts from any other resources or benefits received by you or and/or any members of your household, such as federal veteran’s education benefits, military housing, financial aid, subsidized housing programs, etc. This may also include items that are not required to be reported on the Financial Aid Application or other forms submitted to the Financial Aid Office.

WRITE A DOLLAR AMOUNT OR WRITE IN ZERO IF NOT APPLICABLE DO NOT WRITE N/A OR USE DASHES






Note: We may require additional documentation if we have reason to believe the information is inaccurate.

Certification Statement
I hereby certify that all information on this form is true, complete, and accurate.


Student Electronic Signature
Date: