Legal Dependent Statement
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2015-2016 |
Office of Student Financial Assistance
LEGAL DEPENDENT STATEMENT
____________________________
______________________
Student’s Name:
UCFID:
________________________
Address:
Date:
_________________________________________
____________________________________
_____________________
City:
State/Zip:
____________________________
_______________________
Email Address:
Phone:
Federal regulations define a legal dependent as someone for whom another is providing more than half
financial support.
Please indicate below the amount of support you are providing monthly for the
dependent(s) indicated on your 2015-2016 FAFSA.
1.
Name of
Date of Birth
Relationship
Who does the dependent(s)
Who will claim the
Dependent(s)
live with?
dependent(s) on his/her
2014 taxes?
2. Will you receive monetary assistance from other sources (i.e. child’s other parent, your parents, friends, etc..)?
Yes-
No-
If yes, be sure to include the amounts when completing #6 below.
3. Do you receive Temporary Assistance for Needy Families (TANF)?
Yes-
No-
If yes, the date the benefits began was: _______________
4. Do you receive any public assistance other than TANF?
Yes-
No- If yes, please fill out the chart below.
5.
Type of assistance (WIC, housing assistance, etc..)
Monthly amount received:
Date benefits began:
6.
Monthly
Monthly
Please list name of
amount of support others have
amount of support you have
and will continue to provide for
and will continue to provide for dependent(s) .
person providing
dependent(s). If your 2014 income is not
support, if not student.
enough to provide the support you are
reporting to provide, please submit
documentation on how you provide that
support.
Shelter
Food
Clothing
Medical
Day Care
Other
_____________________________
__________________________
Student’s Signature
Date
Office of Student Financial Assistance
Millican Hall, Room 120 Orlando, FL 32816-0113 Phone: (407) 823-2827 Fax:(407) 823-5241
Legal_Dep1516-Rev.2/15
An Equal Opportunity and Affirmative Action Institution
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