Household Size/status - Verification Form
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1
2RETURN TO:
Name of Financial Aid Applicant (please print)
Office of Financial Aid & Scholarships
Cal Poly Pomona
3801 W. Temple Ave.
Last
First
Middle
Pomona, CA 91768-4008
(909) 869-3700 Phone
Bronco Number:
(909) 869-4757 FAX
2017-2018
HOUSEHOLD SIZE/STATUS – VERIFICATION FORM
Your application was selected for verification. Complete the chart below and return the completed and signed form to our office.
Please keep in mind that incomplete forms and missing requested documents will create delays in processing your financial
aid award.
DETERMINE who is considered a family member. Was your parent’s signature required on the FAFSA?
Section A: Tell Us About Your Family Size
Parent Signature was required on FAFSA (Dependent)
No Parent Signature was required on FAFSA (Independent)
Include the following in the chart:
Include the following in the chart:
Yourself
Yourself
The parent(s) you live with (include step-parent) OR if not
Your spouse if you are married
living at home, the parent(s) whose information was used
Your children ONLY IF you will provide at least 51% of
on the FAFSA.
their support from July 1, 2017 to June 30, 2018.
Your parents’ other children ONLY IF:
Other people currently living with you for whom you
The parent listed will provide at least half of their
currently provide and will continue to provide at least 51%
support from July 1, 2017 to June 30, 2018, OR
of their support from July 1, 2017 to June 30, 2018.
The children would be required to provide parent
information completing the FAFSA.
Other people currently living with your parent(s) for whom
your parent(s) currently provide and will continue to
provide at least 51% of their support from July 1, 2017 to
June 30, 2018.
DO NOT LIST CHILDREN FOR WHOM YOU PAY CHILD SUPPORT.
Full Name
Age
Born before
Relationship to Student
Name of College
January 1,1993
(Yes or No)
STUDENT
SELF
CAL POLY POMONA
Continued on Page 2
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