2020-2021 Income Summary Form
Financial Aid Office, P.O. Box 917, Henderson, NC 27536
Telephone: (252) 738-3280, Fax: (252) 738-3388, Email: fao@vgcc.edu
The income you reported for you and your family on the 2020-2021 Free Application for
Federal Student Aid (FAFSA) appears to be unusually low. Please complete the form and return
it to the Financial Aid Office.
Student Name: Student ID:
NOTE: IF you are a “dependent” by Federal financial definitions, you must provide
parent/stepparent information in the chart and in the paragraph on this form.
Calendar YEAR 2018 Income & Benefits
Sources of Income
Number of
Months Received
Total Amount
for 2018
Employer(s): specify by name below
$ 0.00
$ 0.00
$ 0.00
Child Support Received
$ 0.00
Social Security Benefits/SSI
$ 0.00
Cash Received from other people of
bill paid by others for you.
(Examples: medical expenses,
transportation, insurance,
recreation, clothing, child care,
housing, food, etc.
$ 0.00
Other: specify
$ 0.00
$ 0.00
If the total income above is less than $5,000 for the 2018 year, please explain in writing
how you and your family were able to support yourselves and how you and your family
are planning to do so during the 2020-2021 school year:
Student Signature: Date:
Parent Signature:
(for dependent students)
2020-2021 Income Summary Form
Revised Date: 06/08/2020/FAO
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