Download Low Income Worksheet Parent

North Central State College
Financial Aid Office
low income verification form – parent/s
2016-2017
Student name (print) ____________________________________________ NCSC I.D. ____________________
Because you reported on your FAFSA that you and your parent/s had little or no income in 2015, we need
information which shows how your parent/s supported themselves and their children in that year. Please ask
your parent/s to answer the following questions, and when completed, submit this form to the Financial Aid
Office. If your parents are not married to each other and living together, only the parent you live with or lived
with last should answer the questions on this form.
Answer all questions.
□ Yes
1. Did the parent/s file a federal tax return for 2015?
□ Yes
2. Did parent/s work and earn wages in 2015?
3. Do parent/s:
□ Own their own house
□ No
□ No
□ Rent
4. If rent, how much is the monthly rental charge? $__________
Of this, how much do parent/s pay?
$__________ If they do not pay the entire rent, who pays the rest? _____________________________
How do parent/s obtain the funds to make their rental payment? __________________________________
_____________________________________________________________________________________
5. If parent/s live in their own home, what is their monthly mortgage payment? $____________ How
much do they pay in property taxes every six months? $____________ How do they obtain the funds
to pay their mortgage and property taxes? ___________________________________________________
6. How much, on average, are parents’ utility charges each month? Electric $__________ Gas $_________
Water/sewer $_________
TV $__________
Phone $__________
Internet $__________
How do parent/s obtain the funds to pay for their utilities? _____________________________________
7. How much, on average, do parent/s spend each month for food? $___________ How do they obtain
the funds to pay for food? _______________________________________________________________
8. Do parent/s have other children who live with them?
□ Yes
□ No
9. Does anyone claim parents’ children on their taxes?
□ Yes
□ No
Over
Who? ________________
10. Do parents’ children have medical insurance?
□ Yes
□ No
If yes, who pays for the insurance?
____________________________________________________________________________________
11. How much do parent/s receive each month from the following benefit programs?
Cash welfare $__________ Food Stamps $__________ Unemployment compensation $___________
Child support $__________
Social Security for all members of the family including SSI $__________
Workers’ Compensation $__________
Other $__________
12. Has parents’ personal and/or financial situation changed in 2016 from what it was in 2015? □ Yes □ No
If yes, explain:_________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
13. In addition to completing this form, your parent/s are required to contact the United States Internal
Revenue Service (the federal income tax office.)
• If your parent/s DID file federal taxes for 2015, they should ask the IRS to for a Tax Return
Transcript for 2015.
• If your parent/s DID NOT file federal taxes for 2015, they should ask the IRS for a Non-filer
Statement for 2015. Note that Non-filer Statements are usually not available until after June 15.
The IRS can be contacted by:
• Calling 1-800-829-1040 or
• Going on-line to www.irs.gov or
• Going to the Mansfield IRS office at 180 N. Diamond St. (connected to the main post office.)
Certification - All information presented on this form is true and complete to the best of my knowledge.
Student signature __________________________________________________ Date ____________________
Parent signature ___________________________________________________ Date ____________________
143 Byron Kee Hall
♦
2441 Kenwood Circle
[email protected]
•
Mansfield, Ohio 44906
♦
419-755-4899 (voice) • 419-755-4729 (fax)
♦
http://www.ncstatecollege.edu/cms/financial-aid.html