Dd Form 137-6, Dependency Statement - Full Time Student 21 - 22 Years Of Age Page 3
Download a blank fillable Dd Form 137-6, Dependency Statement - Full Time Student 21 - 22 Years Of Age in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Dd Form 137-6, Dependency Statement - Full Time Student 21 - 22 Years Of Age with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1
2
3
49. STUDENT'S PERSONAL EXPENSES.
List all of the student's personal expenses regardless of who is paying for them.
AVERAGE MONTHLY
AVERAGE MONTHLY
ITEM
ITEM
EXPENSE
EXPENSE
f. PERSONAL TAXES (Specify)
a. CLOTHING
g. PRIVATE AUTO PAYMENTS (If auto is
b. LAUNDRY AND DRY CLEANING
registered in student's name)
h. MONTHLY TRANSPORTATION PAYMENTS
c. MEDICAL (Do not include expenses paid
(Include gas, oil, insurance, repairs, and
by insurance, welfare, or Medicare)
public transportation)
i. OTHER (Specify)
d. VALUE OF USIP CARD (Verification of
amount is required)
e. PERSONAL INSURANCE (Specify)
10. STUDENT'S SCHOOL EXPENSES.
List all of the student's school expenses even if covered by scholarship, grant, or other financial aid.
AVERAGE MONTHLY
AVERAGE MONTHLY
ITEM
ITEM
EXPENSE
EXPENSE
a. TUITION
e. BOARD (Food)
f. OTHER SCHOOL EXPENSES (Specify)
b. BOOKS
c. SPECIAL FEES
d. ROOM (Rent)
11. STUDENT'S INCOME
All gross income received by or in behalf of the student, whether taxable or nontaxable, and whether received monthly, quarterly, or yearly, must be
listed. This includes any income received by persons in the capacity of custodian or administrator for the student. If any income received during the
past 12 months was a lump-sum (one-time) payment, be sure to state this. Verification documents are required.
(1)
(2)
(1)
(2)
PRESENT
TOTAL INCOME
PRESENT
TOTAL INCOME
SOURCE
SOURCE
MONTHLY
FOR PAST 12
MONTHLY
FOR PAST 12
INCOME
MONTHS
INCOME
MONTHS
g. SOCIAL SECURITY PAYMENTS,
a. WAGES, SALARIES, TIPS, OR
DISABILITY OR REGULAR (Specify)
OTHER CASH GRATUITIES
b. INTEREST ON INVESTMENTS,
BONDS, SAVINGS, TRUST
h. SUPPLEMENTAL
FUNDS, ETC.
SECURITY INCOME (SSI)
c. INSURANCE OR PUBLIC/
i. VETERANS ADMINISTRATION
GOVERNMENT PENSION
PAYMENTS, UNEMPLOYMENT
PAYMENTS (Specify type)
OR DISABILITY COMPENSATION
(Specify type)
j. STATE OR LOCAL WELFARE AID,
INCLUDING AID TO DEPENDENT
d. CONTRIBUTIONS FROM
CHILDREN (Include agency and
PERSONS OTHER THAN
MEMBER
address in Remarks section)
k. OTHER (Specify)
e. SCHOLARSHIPS OR
EDUCATIONAL GRANTS
f. TAX REFUNDS (Specify)
12. STUDENT'S EMPLOYMENT
a. HAS STUDENT BEEN EMPLOYED DURING THE PAST 12 MONTHS?
YES
NO (If Yes, furnish the following:)
b. NAME OF EMPLOYER
c. DATE EMPLOYMENT
d. DATE EMPLOYMENT
e. MONTHLY SALARY
STARTED (YYYYMMDD)
ENDED (YYYYMMDD)
(Gross)
f. TYPE OF WORK PERFORMED
g. REASON EMPLOYMENT ENDED
13. MEMBER'S CONTRIBUTION
a. SHOW THE TOTAL AMOUNT THE MEMBER HAS CONTRIBUTED TO THE STUDENT'S SUPPPORT FOR EACH OF THE PAST 12 MONTHS.
(1) MONTH AND YEAR
(2) AMOUNT
(1) MONTH AND YEAR
(2) AMOUNT
(1) MONTH AND YEAR
(2) AMOUNT
ALLOTMENT
PERSONAL CHECK
MONEY ORDER
b. MEMBER PROVIDES SUPPORT BY (X one)
OTHER (Explain)
DD FORM 137-6, FEB 2016
Page 3 of 4 Pages
ADVERTISEMENT
0 votes
Related Articles
Related forms
Form Ca-6 - Combined Offer Of Employment And Work Permit/age Certificate Ca-6 For Minors Under 16 Years Of Age
Education
Form Wh-202 - Application For Authority To Employ Six Or Fewer Full-time Students At Subminimum Wages In Retail Or Service Establishments Or Agriculture Under Regulations 29 C.f.r. Part 519
Legal
Form Wh-201 - Higher Education To Employ Its Full-time Students At Subminimum Wages Under Regulations 29 C.f.r. Part 519
Legal
Form Ca-7 - Combined Offer Of Employment And Work Permit/age Certificate Ca-7 For Minors 16 And 17 Years Of Age
Legal
Related Categories
Parent category: Business