Office of Financial Aid
710 Colegate Drive, Marietta, OH 45750
Phone: 740.568.1908 Fax: 740.376.0257
E-mail: finaid@wscc.edu
2020-2021 Independent Student Statement of Support
Student Name: _____________________________________ WSCC ID: _______________ DOB: _____/_____/________
Based upon information you provided on your Free Application for Federal Student Aid, we need more information on
how you meet your living expenses (and if applicable, provided more than 50% support for your child/dependent).
Are you receiving public assistance or money from somewhere else to help pay your living expenses?
Please explain in detail how you meet your financial obligations such as rent/mortgage, food, utilities, medical
costs, child care, transportation, miscellaneous expenses, etc.
1.) Please describe your living expenses in 2018 and how those expenses were met.
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2.) Who provides your medical insurance? If applicable, who provides your child/dependent’s medical insurance?
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3.) Do you have any income? If so, how much do you receive per month? (Please include Job and Family Services
Benefits (TANF), Social Security, unemployment, child support, disability, etc.)
Source of Income
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Amount per month
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Please Continue on the Back →
4.) What monthly expenses do you have and how much are you paying towards these expenses? Please itemize your
living expenses, how much you pay towards your living expenses each month, and the amount and source of other
assistance you receive to help with each type of living expense.
Type of Expense Amount per month Amount student pays Amount & Source of other assistance
Rent/Mortgage _________________ ________________ ______________________________
Food _________________ _________________ ______________________________
Utilities (gas,
electric, water,etc.) _________________ _________________ ______________________________
Transportation
and Insurance _________________ _________________ _______________________________
Medical expenses
and Insurance _________________ __________________ _______________________________
Clothing _________________ __________________ _______________________________
Cell Phone _________________ __________________ _______________________________
Childcare _________________ __________________ _______________________________
Other _________________ __________________ _______________________________
Other _________________ __________________ _______________________________
5.) SIGNATURE STATEMENT - By signing this verification form, I certify that all of the information reported is complete,
true and correct.
Student’s Signature: ________________________________________________Date: __________________
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