2014-2015 STATEMENT OF LOW (OR NO) INCOME
The Financial Aid Office requires additional financial data for the 2013 calendar year due to your reporting little or no income on your Free Application for
Federal Student Aid (FAFSA).
________________________________________________________________________________________________
Student Name (please print)
Student ID # (If Known)
_______
I certify that I lived in government housing for more than ½ of the calendar year 2013. (You must attach documentation)
_______
I certify that I used my Stafford Loan excess funds for all my living expenses for the calendar year 2013. (The Financial Aid Office may
require further documentation, if you check this option.)
_______
I certify that I lived with parents/other relatives for the entire calendar year 2013 and had no living expenses to pay. (A statement must
be attached to this form from your parent/other relative.)
_______
None of the above. (Please complete the next section of this form.)
Monthly Living Expenses
Please list below you and your spouse/parent(s) average monthly expenses and average monthly income for the calendar year 2013. Monies
received, or paid on your behalf (e.g., your bills), should be entered under Monthly Income-Cash Support. If you are a dependent student, do not
include monies received from your parents with one exception: money from a non-custodial parent that is not part of a legal child support
agreement is untaxed income to the student, and should be listed.
Please attach a letter to explain any discrepancies.
MONTHLY EXPENSES
STUDENT
(& SPOUSE)
MONTHLY INCOME
PARENT(S)
(of Dependent Student)
STUDENT
(& SPOUSE)
Rent/Mortgage
Work (net pay)
Electric/Gas
Business
Water
AFDC/TANF
Telephone
Social Security
Groceries
Veteran’s
Benefits
Car payment
Unemployment
Auto Insurance
Child Support
Gasoline
Disability
Health Insurance
Tips
Clothing
Cash Support
Other
Other
Total
Total
PARENT(S)
(of Dependent Student)
(From Whom)
_____________________________________________________________________________________
Student Signature
Date
_____________________________________________________________________________________
Parent Signature (If Parental Data was Required)
Date