Please Read Carefully!

Complete the requested information on the form 

ONLY IF THE STATEMENT BELOW APPLIES TO YOU

2014-2015 Additional Information Request Form

Student Under 24 who indicated they provide more than 50% of support to a Dependent Child and/or Other Dependent (not including child or Spouse)

Based on the information you reported on your 2014-2015 Free Application for Federal Student Aid (FAFSA), you indicated that you are independent because you have a Dependent of your own or you provide more than 50% of support for another individual.

  A. Student Information





  B. Other Information


You must provide the Office of Student Financial Aid with the following Information:
Are you living at home with your Parent(s)?

What other income sources do you have that you did not report on the FAFSA ? (Check all that apply)





Please attach copies of all W-2(s), current AFDC or ADC Award letter(s), and/or 1099 Statement of Benefits received from Social Security for the 2013 calender year.

Will you and/or your Dependent be claimed on your Parent's 2013 Federal Income Tax Return?


Are you receiving "In-Kind Support" other than money, such as free food and/or housing from:

a. Your dependent's father or mother?
b. Another Family Member?

If yes, please attach a statement, signed and dated be the individual, describing the type of support you are receiving from him/her.

Are you receiving "Cash Support", which is defined as money, gifts, loans, or any other expense(s) paid on your behalf for items

such as housing, food, clothing, car payments or expenses, medical and dental care, and/or college costs?



Please provide a written statement explaining your case in the space below:
  C. Expenses


You, the Student


Student's Parents


Student's Children


Other Dependent(s)













  D.Signatures



Enter Your Full Name


By checking the box below, you certify that all the information reported on this for is complete and correct. If you purposely give false or misleading information, you may be fined, be sentenced to jail, or both.
  E. Parent Certification Section



Enter Parent's Full Name






Select below if you will/ will not provide support to the above listed student for the 2014-2015 academic year.


  F. Attachments



(.pdf, .doc, .docx, .jpg, .txt formats only)


(.pdf, .doc, .docx, .jpg, .txt formats only)
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