2015-2016 |
Office of Student Financial Assistance
HOUSEHOLD SIZE FORM
DEPENDENT
Student’s Name:_______________________________
UCFID:____________________________
Address:_____________________________________
Date: _____________________________
City:_________________________________________
State/Zip:__________________________
Parent’s Name(s):______________________________
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 Parent(s)/Step-Parent(s)
Full Name
Date of Birth
Relationship
Student / Self
Parent 1 (father, mother, stepparent)
Parent 2 (father, mother, stepparent)
B.
Your Siblings:
List siblings who will receive more than half of their financial support from your parent(s) between
July 1, 2015 and June 30, 2016, or are required to use parent information when completing the FAFSA.
Claimed on
Type of
# of credits taking
Date of Birth
If attending college, list:
Parent’s
Full Name
Relationship
Degree
mm-dd-yyyy
College Name, City, State
FALL
SPR
SUM
2014 taxes?
Seeking
15
16
16
John Example
01/25/1993
brother
yes
UCF
Orlando, FL
BA
12
12
0
1.
2.
3.
C.
Other Dependents:
List other dependents who live with your parent(s) AND will receive more than half of their
financial support from your parent(s) between July 1, 2015 and June 30, 2016.
Claimed on
Type of
# of credits taking
Date of Birth
If attending college, list:
Parent’s
Full Name
Relationship
Degree
FALL
SPR
SUM
mm-dd-yyyy
College Name, City, State
2014 taxes?
Seeking
15
16
16
Jane Example
01/25/1993
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 parent’s 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
_____________________________
__________________________
Parent’s Signature
Date
Office of Student Financial Assistance
Dep_hhs1516-Rev02/15
Millican Hall, Room 120 Orlando, FL 32816-0113 Phone: (407) 823-2827 Fax:(407) 823-5241
An Equal Opportunity and Affirmative Action Institution