Fillable 20/21 Proof of Dependent Support Worksheet (North Arkansas College)

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20/21 Proof of Dependent Support Worksheet (North Arkansas College)

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Page 1 of 2
Revised 5/19/2020
North Arkansas College
F
inancial Aid Office * 1515 Pioneer Drive * Harrison, AR 72601
870-391-3266 * Fax: 870-391-3340 * financial-aid@northark.edu
20/21 Proof of Dependent Support Worksheet
Student’s Name: _________________________________________________________
Student’s ID Number: _________________________________________________________
In order to verify your status for federal aid purposes, we must collect this information from students who answered
“yes” to the FAFSA question reporting that you provide more than half the financial support for dependents other than
children.
A. Identify Your Dependent (complete a separate worksheet for each if more than one)
A dependent is any person for whom you will provide financial support between July 1
st
and June 30
th
of the
academic year. Please list those that you will provide more than 50% of the financial support below.
A) They now live with you
B) They now receive more than half their financial support from you
C) They will continue to receive this support from you for the coming academic year
Dependent Name: ______________________________________________________________
Age: _______ Relationship to you: ________________________________________________
B. Dependent Financial Information
Funds Belonging to the Person You Support:
1. Does the person you support have income of their own?
_____ Yes
_____ No
2. Enter the monthly amount of this income that was used for their own support: $____________
3. Enter the monthly amount of this income that was used for other purposes: $____________
4. Does the person you support have any checking/savings accounts or other financial resources?
_____ Yes
_____ No
5. Enter the monthly amount of their resources reported on line 4 used for their own support: $____________
6. Enter the monthly amount of their resources used for other purposes: $____________
C. Monthly Expenses for the Entire Household
7. Lodging (complete item A or B)
A) Mortgage or rent payments $____________
B) If the person you support owns the home, what is the fair rental value $____________
8. Food $____________
9. Utilities $____________
10. Other $____________
11. TOTAL: $____________
12. Total number of persons living in household $____________
13. Each person’s part of the household expenses (line 11 divided by line 12) $____________
2020-2021
Page 2 of 2
Revised 5/19/2020
D. Total Expenses for the Person You Supported
a. Each person’s part of the household expenses (total from line 13) $____________
b. Average monthly expenses for clothing $____________
c. Average monthly expenses for education $____________
d. Average monthly expenses for medical/dental $____________
e. Average monthly expenses for travel/recreation $____________
f. Other (please specify) _____________________________________ $____________
14. TOTAL cost of support for the month (add a - f) $____________
E. Support Evaluation
15. 50% of line 14 (line 14 divided by 2) $____________
16. Add lines 2, 5 and 7b if the person you support owns the home $____________
If line 16 is greater than line 15 STOP. You are not providing more than 50% of the person’s support. Please correct
your FAFSA, if you are under the age of 24 you will need to provide parent information.
If line 15 is great than line 16 continue.
17. Amount others provided monthly for the person you support. This includes amount provided by sate/local
welfare agencies or amounts provided by other family members to pay the person’s expenses (excludes
child support). $____________
18. Amount you provide monthly for support:
a. Income from work $____________
b. Benefits (ex Social Security/unemployment) $____________
c. Child support/alimony received $____________
d. Savings/investments/retirement $____________
e. Other (list: _________________________) $____________
TOTAL: $____________
If line 18 is great than line 15 then you meet the support test for the person(s) and qualify as an independent for
financial aid purposes.
If line 18 is less than line 15 then you do not meet the support test for the person(s) and must correct your FAFSA
responses (you may be required to provide parental information if you are under the age of 24)
By signing this worksheet the student certifies that the above information is a true and complete representation of their
financial status. The student agrees to provide supporting documentation if requested.
Student signature: ___________________________________________________ Date: ____________________
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2021 Proof of Dependent Support Worksheet (North Arkansas College)

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Completed 25 July 2020

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