2019-2020
RECEIPT OF SNAP BENEFITS
(DEPENDENT)
(FFFA02)
S
TUDENT
I
NFORMATION
_______________________________________________________ ______________________________
_
Last Name First Name M.I.
Student ID#
By signing this document, the parent certifies that at least one member of the parents’ household, received benefits from
the Supplemental Nutrition Assistance Program or SNAP (formerly known as the Food Stamp Program) sometime
during 2017or 2018. SNAP may be known by another name in some states (CalFresh). For assistance in determining
the name used in a state, please call 1-800-4FED-AID (1-800-433-3243).
The parents’ household includes:
• The student.
• The parents (including a stepparent) even if the student doesn’t live with the parents.
• The parents’ other children if the parents will provide more than half of the children’s 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 FAFSA for 2019–2020. Include children who meet either of these standards
even if the children do not live with the parents.
• Other people if they now live with the parents and the parents provide more than half of their support and
will continue to provide more than half of their support through June 30, 2020.
Note: If we have reason to believe that the information regarding the receipt of SNAP benefits is inaccurate, we
may require documentation from the agency that issued the SNAP benefits in 2017 or 2018.
C
ERTIFICATION AND SIGNATURES
Each person signing this form certifies that all the information
reported is complete and correct. The student and at least one
parent must sign and date.
Student: Date:
Parent: Date:
Print Parent Name: ____________________________
__________
RETURN TO FINANCIAL AID OFFICE:
WARNING: If you purposely give false or
misleading
information on this worksheet,
you may be fined,
sentenced to jail, or both.
