Dependent V1 Worksheet - Elizabethtown College (Page 2 of 2) in pdf

B) Food Stamps

(You MUST check one)

Did your parent(s) or a member of their household receive SNAP (Food Stamps) in 2014 or 2015?

☐YES. The parent(s) certifies that _________________, a member of the parent(s) household, received benefits from the

Supplemental Nutrition Assistance Program or SNAP (formerly known as Food Stamp Program) sometime during 2014 or 2015.

*If more than one person receives SNAP attach a separate page with the name of the individuals getting the benefits

☐NO. The parent(s) or any member of their household did not receive SNAP (Food Stamps) in 2014 or 2015.

C) Family Information

Complete the grid below for all of your family members who live in your household and are listed on your FAFSA.

Always include yourself and your parent (s) or stepparent (s). Include siblings or other relatives (a) who live with

you; (b) receive more than half of their support from your parents; and (c) who will continue to receive that support

between July 1, 2016 and June 30, 2017. List the schools and colleges which any household member, excluding the

parents, will attend at least half time, in a degree, diploma, or certificate program at a postsecondary educational

institution anytime between July 1, 2016 and June 30, 2017.

Full Name

Age

Relationship

School/College in 2016-2017

(Must be Enrolled at Least Half Time)

SELF

ELIZABETHTOWN COLLEGE

*If more space is needed, attach a separate page with the student’s name and ID at the top

D) Child Support Paid

Complete this section only if your parent (s) paid child support during 2015.

Name of Person who Paid Child

Name of Person to Whom

Name of Child for Whom

AGE of

Amount of

Support

Child Support was Paid

Support Was Paid

Child

Child Support

Paid in 2015

*If more space is needed, attach a separate page with the student’s name and ID at the top

E) Certification and Signatures

Each person signing this worksheet certifies that all of the information is complete and correct. The student and one

parent whose information was reported on the FAFSA must sign and date this worksheet. Warning: If you purposely

give false or misleading information on this worksheet, you may be fined, be sentenced to jail, or both.

Student Signature___________________________________________________ Date ___________________

Custodial Parent Signature ____________________________________________ Date ___________________

Please return completed forms to the Financial Aid Office.

Dependent V1 Worksheet - Elizabethtown College Page 2