2019-2020
STATEMENT OF OTHER LEGAL DEPENDENTS
(FFFA79)
S
TUDENT
I
NFORMATION
_____________________________________________________________
Last Name First Name M.I.
Student ID#
On the Free Application for Federal Student Aid (FAFSA) you indicated that you have other legal dependent(s). Other
legal dependent is a person (other than your child or spouse) who lives with you and who receives more than 50% of
their support from you, now and through June 30, 2020.
If you are not supporting a person that meets the above definition: update your answer to question number 52 on
your FAFSA (Other Legal Dependents), add your parent(s) information to your FAFSA, and disregard this form.
If you have other legal dependents that meet the above definition, please list them below:
Other
Legal Dependent Name: Relationship: Age:
Other Legal Dependent Name: Relationship: Age:
Other Legal Dependent Name: Relationship: Age:
Other Legal Dependent Name: Relationship: Age:
Other Legal Dependent Name: Relationship: Age:
Please provide a written statement explaining how you are currently providing room, board, and personal expenses for
the other legal dependent(s) listed above during this academic year (July 1, 2019 through June 30, 2020).
(Do not include your child or spouse).
Note: The college may request additional supporting documentation at any time.
C
ERTIFICATION AND SIGNATURE
By signing this form, I certify that all the information reported
to qualify for federal student aid is complete and correct.
Student Signature: Date:
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.
