Student's Name:
Student ID/SSN:
Your parent(s) have reported unusually low income for the base tax year. You must provide additional information about your parent(s) income and expenses in 2011 to complete your financial aid processing.
NOTE: If you indicated N/A for all the line items in Section II, you MUST provide a statement as to how you supported yourself in 2011.
Section I (Housing)
1. With whom did you live with in 2011?
Family
Roommate/Significant/Other
By Yourself
2. In 2011, did your name appear on the Mortgage or Lease Agreement?
Yes
No
Section II: Parent Statement of Income (questions that don’t apply enter N/A for not applicable)
- 2011 EXPENSES: Indicate below who covered your yearly expenses for 2011. Provide the name(s) and relationship(s) of who paid the expense or provided the item for you. If you paid the cost, enter “Self”.
- 2011 Income: Identify the source of your yearly income for the year 2011.
I was married, supported by my spouse, and now I am separated, divorced or widowed. I had income of $
for 2011 (do not include spouse’s income). (If no income, enter 0). This amount must be reported on the FAFSA as income earned from work or as untaxed income.
Please describe any special circumstances regarding your source(s) of income for 2011 in the space provided.
I hereby certify that all information above is true and complete. I have not knowingly or intentionally provided any false statements or fraudulent documentation. I understand that if I am found to have knowingly or intentionally given false or fraudulent statements and/or documentation, eligibility for aid can be jeopardized.
By my signature I attest to having answered the following questions truthfully. |
