2019–2020 Dependent Household Size Verification Form
Your financial aid application was selected by the U.S. Department of Education to undergo a process called
verification. You and your parent must complete, sign, and submit this form listing the name and age of each of your
parent(s)’ household members and their relationship to you. The form must be submitted to the Financial Aid Office to
continue the review process and determine your eligibility for federal student aid.
A. Student Information
__________________________________________________ ________________
Student’s Name (Last, First, M.I.) Student ID - REQUIRED
B. Household Information
List the people in your parent(s)’ household. Include the following:
• Yourself
• Your parent(s), including a stepparent, even if you do not live with your parent(s).
• Your parent(s)’ other children if your parent(s) will provide more than half of their support from July 1, 2019 through
June 30, 2020, or if the other children would be required to provide parental information if they were completing a
2019-2020 federal financial aid application. Include children who meet either of these descriptions, even if they do not
live with your parent(s).
• Other people if they now live with your parent(s) and your parent(s) provide more than half of their support and will
continue to provide more than half of their support through June 30, 2020.
If more space is needed attach an additional sheet with the student’s name and ID at the top. The student and parent must sign
and date the additional sheet.
C. Certification and Signatures
Each person signing below certifies that all the information reported on this worksheet is complete, correct, and any additional
information is attached. The student and one parent MUST sign and date this section.
WARNING: If you purposely give false or misleading information on this worksheet you may be fined, sentenced to jail,
or both.
______________________________________________________________________ _______________
Student’s Signature Date
______________________________________________________________________ _______________
Parent Signature Date
