HOUSHLDD16
2016-2017 CLARIFICATION OF HOUSEHOLD SIZE AND NUMBER IN COLLEGE
(Dependent)
Student Last Name
First Name
Middle I.
Student NCC ID# or Social Security #
You are required to complete and return this form in order for verification of your financial aid eligibility to be completed. This form is required in
order to resolve conflicting information regarding the number of household members your parent(s) are providing more than 50% of the support
for and/or the number of family members who will be enrolled at least half-time for the period July 1, 2015 through June 30, 2016.
You are considered a Dependent student and should include in your parents’ household:




Yourself, even if you don’t live with your parents
Your parents
Your parents’ other children if (a) your parents will provide more than half of their financial support
between July 1, 2016 and June 30, 2017, or (b) the children could answer “No” to every dependency status
question on the FAFSA
Other people if they now live with your parents, your parents provide more than half of their financial
support and your parents will continue to provide more than half their financial support between July 1,
2016 and June 30, 2017.
Do not include:
 Family members who live in the same household as your parents, but your parents cannot provide

Household Member
documentation to demonstrate that they provide at least half of their support
Friends or others who live in the same household as your parents, but your parents cannot provide
documentation to demonstrate that they provide at least half of their support
Age
Relationship to
Student
SELF
Name of College attending at least
half time July 1, 2016 through June
30, 2017 (do not include parents
attending college)
Northampton Community College
Will your parents provide more
than 50% of their Support July
1, 2016 through June 30, 2017
(check one)
X Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
No
No
No
No
No
No
No
No
No
No
No
Certification and Signature: I declare that the information reported is true, correct and complete to the best of my knowledge
and belief. I understand that for federal financial aid purposes if I knowingly give false or misleading information, I may be fined,
sentenced to jail, or both. I understand that submission of incomplete information may delay my financial aid processing.
____________________________________ _______________ ____________________________________ _______________
Student Signature
Date
Parent Signature
Date
Return completed form to: Financial Aid Office, Northampton Community College, 3835 Green Pond Road, Bethlehem, PA 18020-7599
By Fax: 610-861-4565