Monthly Income And Expense Verification Form Dependent 2015-16 - Vcu - Virginia

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2015-2016 MONTHLY INCOME & EXPENSE VERIFICATION FORM
DEPENDENT
To accurately evaluate your eligibility for financial aid, our office requires that you provide supplemental documentation of your income
and assets reported on your FAFSA. Please complete this form, explaining how you and your parent(s) were able to cover expenses such
as housing, food and utilities during the 2014 calendar year. The parent information must be completed if you were required to submit
parental information on the FAFSA.
NAME ____________________________________________________________________
Last
First
Student ID Number
MI
ADDRESS ____________________________________________________________________________________________________
Street Address
Apt. #
City
State
Zip Code
DATE OF BIRTH ___________________________________________ EMAIL ADDRESS _______________________________________
HOME PHONE NUMBER _____________________________________ ALTERNATE/CELL-PHONE NUMBER __________________________
(Including area code)
(Including area code)
SECTION A: INCOME
The form will be returned if you leave a field blank. If the answer is zero enter “0” or “N/A.”
Parent(s) 2014 Income
Amount Per
Student 2014 Income
Amount Per
Month
Month
Income from work (gross amount)
Income from work (gross amount)
Business income
Business income
Social Security Benefits
Social Security Benefits
Unemployment Benefits
Unemployment Benefits
Child support
Child support
Worker’s compensation
Worker’s compensation
Disability Benefits
Disability Benefits
Alimony
Alimony
SNAP/Food Stamps
SNAP/Food Stamps
TANF
TANF
Rental assistance
Rental assistance
Cash assistance from family and friends
Cash assistance from family and friends
Cash received or money paid on your behalf
Cash received or money paid on your behalf
Other sources
Other sources
TOTAL INCOME =
TOTAL INCOME =
Office of Financial Aid
Grace E. Harris Hall Student Service Center
1015 Floyd Ave., 1st Floor
P.O. Box 843026
Richmond, VA 23284-2520
•
•
•
•
(804) 828-1550
Fax (804) 827-0060
•
•
VCU is an EEO/AA institution. ENR1314-121

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