Low Income Worksheet For Parents - 2015-16 printable pdf download

SJC Central

SJC North

SJC South

Campus Financial Aid Services Office

8060 Spencer Highway, Pasadena, TX 77505

5800 Uvalde Road, Houston, TX 77049

13735 Beamer Road, Houston, TX 77089

281-998-6150

SAN JACINTO COLLEGE PARENT LOW INCOME WORKSHEET FOR 2015-2016

Student’s name: ______________________________________ Student’s SSN: _______________________________

The income reported on the 2015-2016 Free Application for Federal Student Aid appears unusually low. Therefore, additional information is needed

before processing of your student’s financial aid application can continue. Please itemize your resources received from January 1, 2014, through

December 31, 2014. Note: No further action will be taken on your student’s application until this information is received.

2014 INCOME AND OTHER RESOURCES: Report amounts for all the different types that apply to your family’s situation. Please list

the total 2014 amount for the year (not monthly amounts).

Annual Amounts ONLY

1. Wages - Income earned from working

(parent1) $___________ + (parent2) $__________ =Total $___________

2. Business income - Income earned from your business (parent1) $___________ + (parent2) $__________ =Total $___________

3. Interest/Dividends - Income received from bank accounts/stocks

$___________

4. Living Assistance - Housing, food, utilities and other living assistance/allowances from churches,

BAQ, HUD, or others, except from parents, family & friends

(Include cash and cash value)

$___________

5. Supplemental Nutrition Assistance Program (SNAP) - Value of SNAP benefits received

$___________

6. Temporary Assistance for Needy Families (TANF) - Report total funds received

$___________

7. Social Security Benefits - Report total 2014 funds received for each family member (Including SSI):

(parent1) $_________ + (parent2) $__________ + (children) $________ + (legal dependents) $________ =Total $__________

8. Worker’s Compensation - Report total funds received

$__________

9. Unemployment/Severance - Report total funds received - (parent1) $__________ + (parent2) $________ = Total $__________

10. Alimony - Report total amount received

$__________

11. Child Support Received - Report amount received for the year

$__________

12. Disability - Report any funds received

$__________

13. Parents, Family and Friends - Housing, food, utilities and other contributions received from parents,

family, and friends (include cash and cash value)

$__________

14. Other_________________________________ - Report any other funds or support received from any

source not previously reported on this form.

$__________

(Name Source)

15. Total 2014 Income and other Resources (Add columns 1 through 14)

$________________

Please provide a written explanation that describes how you were able to pay for your family’s living expenses in 2014. (If you

need additional space, please use the back of this form).

___________________________________________________________________________________________________________

Parent’s Signature: _________________________________________________ Date: ____________________________________

Please return the completed form to your Campus Financial Aid Services Office.

Low Income Worksheet For Parents - 2015-16

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