Household Information Form

Household Information Form
Student Information:
Student ID #
Name
First NameLast Name
Address
Street Address
Street Address Line 2
CityState / Province
Postal / Zip Code
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Date of Birth
MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Dependency Status
Dependent Students:
Please list the names of people in your parents’ household, including the following (if applicable):
- Parent(s) including step-parents, even if you
- don’t live with your parents, and
- Siblings and/or step-siblings, even if they don’t live with your parent(s) and if
  - (a) your parents will provide more than half of their support
  - (b) They would be required to provide parental information when applying for Federal Student Aid, and
- Others living within your household and your parents provide more than half of their support.
Independent Students:
Please list the people in your household:
- Your spouse (if married)
- your children, even if they do not live with you, provided that they are still your dependents; and
- Other members of your household living with you and which you provide for their cost of living expenses;
Family household list
Certification
By signing this form, I certify that all information I have provided above are true and correct to the best of my knowledge. I understand that any willful act of representation of any false information may cause my disqualification of my application for student aid.
Signature
Clear
Date
MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Should be Empty: