Independent Low Income Statement Form - 2015-2016
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1INDEPENDENT LOW INCOME STATEMENT
2015 – 2016
Your application for financial aid was selected for review in a process called “Verification”. Based upon a review of your total resources
reported on your Verification Worksheet (V6) and your 2014 expenses reported on the Low Income Expense Form, it was determined that
your total living expenses (reported on the Low Income Expense Form) exceed the total 2014 income/resources (reported on the
Verification Worksheet V6). As a result, you must explain via this statement how expenses were covered since the income/resources were
less than the expenses.
A. Student Information
STUDENT NAME: _____________________________________________ GCU STUDENT NUMBER: _____________________________
Address: ___________________________________________________ Date of Birth: _______________________________________
City: __________________________ State: ___________ Zip: ___________ Phone No.:_______________________________________
B. Office of Financial Aid Use Only --> Calculation of Shortage
This section to be completed ONLY by the GCU Office of Financial Aid.
Calculated income/resources reported to IRS & GCU: ____________________
Expenses documented on Low Income Expense Form: ____________________
Amount of expenses not covered by income (i.e. shortage): ____________________
C. Student Statement Explaining How Expenses Were Covered Given the Shortage Noted in Section B
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D. Certification and Signature
(Handwritten Signature Required – Typed/Electronic Signature Not Accepted)
By signing below the student whose information was reported on the FAFSA certifies that all of the information reported is complete
.
and correct
Student Signature: _____________________________________________________
Date: ____________________________
WARNING: Providing false or misleading information may be punishable by fines, jail, or both.
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