Dependent Student Civil Union Worksheet Page 2
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1
2Civil Union Partner
Parent
C: Asset and Expense Information
15A.
15B.
$___________________.00
$____________________.00
15. Cash, savings and checking accounts
16A.
16B.
$___________________.00
$____________ _______.00
16. Other real estate and investments
(Don’t include the home in which your parents live in)
17A.
17B.
$___________________.00
$____________ ______.00
17. Business/Investment farm*
* Do not include the value of a family farm that a parent (and/or civil union partner) lives on and
operates. Do not include the value of a small business that a parent (and/or civil union partner)
owns and controls that has 100 or fewer full-time or full-time equivalent employees.
D: Household Information
19. Number of college
18. How many people are in your
parent’s and his/her civil union
students in 2015-2016
partner’s household?
Enter the number of
Include:
family members included
• yourself, even if you don’t live with your parent,
in item 5 who will be in
• your parent and his/her civil union partner,
college at least half time.
• your parent’s other children and his/her civil union partner’s other
Include the student who is
children if your parent and/or his/her civil union partner will provide
more than half of their support between July 1, 2015 and June 30, 2016
applying for aid.
Do not include parent or his/her civil union partner.
E: Other Information and Signatures
20. COLLEGE ATTENDANCE
Effective
Fall 2015
Spring 2016
Name of College
City
21. In 2013 or 2014, did the parent (and/or civil union partner) or
Civil Union Partner/Other Household Member Student
*---anyone in their household receive benefits from any of the
21A.
21F.
Supplemental Security Income (SS)
Supplemental Security Income (SSI)
---
federal benefit programs listed?
21B.
21G.
Supplemental Nutrition Assistance
Supplemental Nutrition Assistance
Program (SNAP)
Program (SNAP)
(Mark all of the programs that apply.)
21C
21H.
Free or Reduced Price Lunch
Free or Reduced Price Lunch
21D.
21I.
Temporary Assistance for Needy
Temporary Assistance for Needy
Families (TANF)
Families (TANF)
21E.
21J.
Special Supplemental Nutrition
Special Supplemental Nutrition
Program for Women, Infants, and
Program for Women, Infants, and
Children (WIC)
Children (WIC)
Please be advised that the New Jersey Higher
Education Student Assistance Authority has the right
to audit/verify this information to ensure your State
student aid eligibility was accurately determined.
_____________________________ Date ___/___/ ____
Student’s Signature
By signing, I (we) certify that the information provided herein is true
and accurate to the best of my (our) knowledge. I (we) understand that
(Please print) ___________________________________________
this information will be used by the New Jersey Higher Education
Student Assistance Authority (HESAA) to determine eligibility for State
student financial aid programs, such as the Tuition Aid Grant program.
_______________________________ Date ___/___/ ____
Parent’s Signature
I (we) recognize that the information provided herein will be transferred
as required to institutions designated as authorized recipients on the
(Please print) ___________________________________________
Free Application for Federal Student Aid or other notification of change
in college choice and I (we) specifically authorize HESAA to release
that information for those purposes.
______________________ Date ___/___/ ____
Civil Union Partner’s Signature
(Please print) ___________________________________________
Revised 04/01/15
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