DLGD20 Rev. 3/18/19
Office of Financial Aid
2019-2020
PROOF OF PARENT(S)’
LEGAL DEPENDENTS
Student name: SCC ID #:
Your parent(s) has indicated on the FAFSA that he or she has a legal dependent other than a spouse or child for whom more than
50% support is provided. To include someone as a dependent, current support plus future support must be more than 50% from
July 1, 2019 through June 30, 2020. Please provide all documentation showing at least 50% support for the dependent(s) listed
below. You must provide sufficient documentation to prove support for any legal dependents.
Failure to submit all documentation will result in a correction to the student’s FAFSA to remove legal dependent(s)
information.
WARNING: If you purposely give false or misleading information on this worksheet, you will be reported to the Department of
Education. You may be fined, sentenced to jail, or both.
Instructions: List all dependent(s) other than a spouse or child below. Support for your dependent(s) includes housing, food,
clothing, medical and dental care, childcare, money, gifts, and anything else your parent(s) may provide. Resources that enable your
parent(s) to provide the support can include earnings received from work or in-kind support (housing/food in exchange for work) and
assistance received from other agencies (Medi-Cal, TANF, SNAP, etc.). Attach additional documentation as needed.
Name of dependent Age Relationship to Date he/she began Other sources of
Sara Jones (example)
12
Niece
1/1/2010
SSI, WIC, SNAP, Medi-Cal,
If more space is needed, please attach a separate page with the student’s name and SCC ID number at the top.
My parent(s) provided more than 50% support for the person(s) listed above, and attached ALL of the following:
1.
Written statement detailing why the person(s) listed above are dependent on your parent(s). Please include:
-
Who claims the child/dependent on federal taxes?
-
Who pays (or will pay) for childcare, if applicable?
-
Who pays (or will pay) for food and medical needs?
-
If the dependent is over 24 years old, he or she MUST provide a written and signed statement
regarding your parent’s contribution of more than 50% of his or her support.
2.
Documentation of dependent(s)’ income and/or benefits from all sources
3.
Documentation of benefit(s) your parent(s) provided
My parent(s) cannot attach any documentation and has provided a written statement explaining why
By signing this form, we certify that all information is complete and correct to the best of our knowledge.
Student Signature Date
Parent Signature Date
