2013-14 Household Data Form
Dependent Student
Office of Financial Aid
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Phone: 734.487.0455
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Fax: 734.487.4281
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Email: financial_aid@emich.edu
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Web: www.emich.edu/finaid
Name
As part of the Quality Assurance Verification process, please complete and submit this form regarding the members of
your parent(s) household.
List the family members in your parent(s)’ household. Include:
• Yourself and your parent(s), even if you don’t live with your parents. Include your step-parent if your parent has
remarried.
• Your parents’ other children, even if they don’t live with your parent(s), if your parents will provide more than half of
their support from July 1, 2013 through June 30, 2014, and
• Other people if they now live with your parents, and your parents provide more than half of their support and will
continue to provide more than half of their support from July 1, 2013 through June 30, 2014.
Write the names of all household members in the space(s) below. Also write in the name of the college for any
household member, excluding your parent(s), who will be attending at least half time between July 1, 2013 and June 30,
2014, and will be enrolled in a degree, diploma, or certificate program. If you need more space, attach a separate page.
Each person signing this form certifies that all the information reported on it is complete and correct.
The student and at least one parent must sign and date.
Student Signature Date
Par
ent Signature Date
Eastern Michigan
University
