Household Size Form - 2015-2016
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12015-2016 |
Office of Student Financial Assistance
HOUSEHOLD SIZE FORM
INDEPENDENT
Student’s Name:_______________________________
UCFID:____________________________
Address:_____________________________________
Date: _____________________________
City:_________________________________________
State/Zip:__________________________
Spouse’s Name:_______________________________
Phone:____________________________
Complete items A through D carefully
. Be sure to provide complete information for each household member and enter
N/A for items that do not apply. Leaving items blank on any household member can result in processing delays.
A
. You and Your Spouse (if married)
Type of
# of credits taking
If attending college, list:
Full Name
Date of Birth
Relationship
Degree
FALL
SPR
SUM
College Name, City, State
Seeking
15
16
16
SELF/STUDENT
SPOUSE
B.
Your Children:
List children who will receive more than half of their financial support from you (and your spouse if
married) between July 1, 2015 and June 30, 2016, or are required to use your information when completing the FAFSA.
Type of
# of credits taking
Date of Birth
If attending college, list:
Claimed on
Full Name
Relationship
Degree
FALL
SPR
SUM
mm-dd-yyyy
College Name, City, State
2014 taxes?
Seeking
15
16
16
John Example
01/25/1993
son
yes
UCF
Orlando, FL
BA
12
12
0
1.
2.
3.
C.
Other Dependents:
List other dependents who live with you (and your spouse if married) AND will receive more than half
of their financial support from you (and your spouse if married) between July 1, 2015 and June 30, 2016.
Type of
# of credits taking
Date of Birth
If attending college, list:
Claimed on
Full Name
Relationship
Degree
FALL
SPR
SUM
mm-dd-yyyy
College Name, City, State
2014 taxes?
Seeking
15
16
16
Jane Example
06/25/2008
niece
yes
n/a
n/a
n/a
n/a
n/a
1.
2.
3.
D.
Federal Means Tested Benefit Programs:
Did any member of your household size receive any of the following
federal benefits in 2013 or 2014?
Supplemental Security Income (SSI from SSA Form 2458)?
Yes
No
WIC?
Yes
No
Free or Reduced Lunch?
Yes
No
Food Stamps (SNAP)?
Yes
No
Temporary Assistance for Needy Families (TANF)?
Yes
No
_____________________________
__________________________
Student’s Signature
Date
_____________________________
__________________________
Spouse’s Signature
Date
Office of Student Financial Assistance
Indep_hhs1516-Rev.02/15
Millican Hall, Room 120 Orlando, FL 32816-0113 Phone: (407) 823-2827 Fax:(407) 823-5241
An Equal Opportunity and Affirmative Action Institution
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