2012 Low Income Documentation

You reported low income for the 2012 calendar year on your 2013-2014 Free Application for Federal Student Aid (FAFSA). Answer the following questions as specifically and thoroughly as possible to help us document your financial aid file. *Note: Be aware that you may be asked to provide proof that you provide more than 50% financial support to your dependent child.

Student’s Name: _____________________________________________ CID: ____________________

1. Name and Address of with whom and where you lived during the 2012 calendar year:

Name__________________________________ Relationship to you: _________________

Address_______________________________City_____________________State_______

2. Were you responsible for any housing, utility and/or food costs? _____Yes ______No

a. If yes, what amount did you pay for:

i. Housing (Rent)___________________

ii. Utility __________________________

iii. Food ___________________________

3. How much did you earn from working in 2012? ____________________________________

4. What source of untaxed income did you have in 2012? ______________________________

5. Did you receive child support? ______ Yes ______ No

a. If yes, what was the total you received for the 2012 year? ____________

6. Did you have a car payment? _____ Yes _____No

a. If yes, what amount did you pay per month? _______________

b. If yes, what amount did you pay for car insurance per month? ______________

7. Did you receive:

a. TANF ______Yes ______No

b. SNAP_______Yes ______No

c. Other form of Government Assistance (i.e. Subsidized Housing) _____Yes ______No

i. If yes, list type ___________________________

I certify that the above information is true and correct to the best of my knowledge. I further understand that if I purposely give false or misleading information, I may be reported to the Inspector General’s Office.

_________________________________ _____________________
Student’s Signature Date

Del Mar College is an Equal Opportunity/Affirmative Action Institution