Independent Student/spouse Low Or No Income Verification Form
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1East Carolina University
Office of Student Financial Aid
2016-2017 Independent Student/Spouse Low or No Income Verification Form
Student Name: _____________________________ ECU (Banner ID: ___________________
This information is being requested because the income reported on your 2016-2017 Free Application for Federal Student
Aid (FAFSA) appears low for your household size. So that we can fully understand your financial situation, please provide
below all information about other resources, benefits and other amounts you and/or your spouse received between
January 1, 2015 to December 31, 2015. This may include items that were not required to be reported on the FAFSA.
Write ‘0’ for items that do not apply. Do Not Leave Blanks.
STUDENT AND SPOUSE (if applicable) YEARLY INCOME
STUDENT
SPOUSE
Income Earned from Work by Student (W2’s required, and/or 1099’s/
Schedule C from 1040 for self-employed):
$
$
If you did not keep a copy of your W-2, please contact your employer
Income Earned from Work by Spouse (W2’s required, and/or 1099’s/
Schedule C from 1040 for self-employed):
$
$
If you did not keep a copy of your W-2, please contact your employer
Social Security Benefits (received by Student or Spouse ):
$
$
Supplemental Security Income (SSI):
$
$
WIC Program:
$
$
Supplemental Nutrition Assistance Program (SNAP-Food Stamps):
Submit 2016-17 Student Verification of SNAP Form at , and attach
$
$
documentation of benefits received.
Temporary Assistance to Needy Families/Welfare Benefits (TANF):
$
$
Federal Veterans Educational benefits: Montgomery GI Bill, Dependents
Education assistance Program, VEAP Benefits, Post 9/11 GI Bill:
$
$
Military Housing Allowance:
$
$
Alimony Received:
$
$
Financial Aid Refund from loans or grants received for 2015-16
$
$
Other:__________________________________________________
$
$
Do you receive housing assistance? YES _____
NO_____
If you report all zeroes above, please explain how you and/or your spouse covered housing, utility, and food
expenses in 2015:
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
Student’s Signature: __________________________________________
Date: _________________
Spouse’s Signature: __________________________________________
Date: _________________
Please complete, sign, and return this form via mail to: Office of Student Financial Aid, East Carolina University, 2103 Old
Cafeteria Complex, Mail Stop 510, Greenville, NC 27858, via email to faques@ecu.edu, or via fax to 252-328-4347. If you have
any questions, please contact our office at 252-328-6610. Failure to complete and return this form will delay the processing of
your financial aid. Questions left blank will cause this form to be returned to you.
16-17 Independent Student Income Verification
Rev. 1/2016
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