IECC 2013-2014Documentationof Household Members Worksheet

Federal Student Aid Programs

Complete this worksheet and submit it to your financial aid administrator as soon as possible so that your financial aid won’t be delayed.

What you should do:

  1. Talk to your financial aid administrator if you have questions about completing this worksheet.
  2. Your financial aid administrator will compare information on this worksheet and any supporting documents with the information you submitted on your application. You or your school may need to make corrections electronically or by using your SAR.

STUDENT INFORMATION

Name / SSN/ID
Address / Date of Birth
City / State / Zip / Phone

FAMILY INFORMATION

List the people in your parent(s)’ household, including:

•yourself and your parent(s) (including stepparent) even if you don’t live with your parent(s)

•your parent(s)’ other children if your parents(s); will provide more than half of their support from
July 1, 2013 through June 30, 2014, even if they don’t live with you, and,

•other people if they now live with your parents and they provide more than half of their support and will continue to provide more than half of their support from July 1, 2013 through June 30, 2014.

Write the names of all household members in the space(s) below. Also write in the name of the college for any household member, who will be attending at least half time between July 1, 2013 and June 30, 2014 and will be enrolled in a degree, diploma, or certificate program. If you need more space, attach a separate page.

Full Name / Age / Relationship / College

SNAP BENEFITS

Yes or No Did you (or your parents) receive Supplemental Nutrition Assistance Program (SNAP) benefits (formerly known as food stamps) during 2012? (Agency documentation may be needed)

CHILD SUPPORT

Yes or No Did you (or your parents) pay child support in 2012? If yes, complete the table below.(Supporting documentation may be needed)

Who paid support? / Adult whom you paid? / Child’s name? / Amount in 2012?
EX: Chris Smith / Mary Jones / Terry Smith / $4,800.00

Sign this Worksheet

The person signing this form certifies that all the information reported on it is complete and correct. Studentand Parent must sign and date. / WARNING: If you purposely give false or misleading information on this worksheet, you may be fined, be sentenced to jail, or both.
Student’s Signature / Date
Parent’s Signature / Date

Revised 1-28-2013