B. Number of Household Members: List below the people in the parents’ household. Include:
The student.
The student's spouse, if the student is married.
The student's or spouse's children if the student or spouse will provide more than half of the children's support from July 1, 2020,
through June 30, 2021, even if the child does not live with the student.
Other people if they now live with the student and the student or spouse provides more th
an half of the other person’s support,
and will
continue to provide more than half of that person’s support through June 30, 2021.
Number in College: Include in the sp
ace below information about any household member, excluding the parents, who is, or will be,
enrolled at least half time in a degree, diploma, or certificate program at an eligible postsecondary educational institution any time
between July 1, 2020, and June 30, 2021, and include the college name.
If more space needed, provide a separate page with the student’s
nam
e
and
ID
n
um
ber at
t
he top.
Full Name Age Relationship College
Will be Enrolled at
Least Half Time
Yes or No
Self New River CTC
Note: We may require additional documentation if we have reason to believe that the information regarding the household members
enrolled in eligible postsecondary educational institutions is inaccurate.
C. During 2018 and/or 2019, did any person(s) listed in Section B receive any of the following benefits:
Medicaid Yes No, Supplemental Security Income (SSI) Yes No, SNAP Yes No,
TANF Yes No, Free or Reduced Lunch Yes No, and/or WIC Yes No?
D. Statement of Educational Purpose
I certify that I ____________________________________ am the individual signing this Statement of Educational Purpose and
(Print Student’s Name)
that the Federal student financial assistance I may receive will only be used for educational purposes and to pay the cost of
attending New River Community and Technical College for 2020-2021.
E. Statement of Financial and Eligibility / Adjustments
I understand that I may lose or be required to repay funds I have been awarded or already received. If additional grants,
scholarships, loans, etc., are awarded to me by any agency. I realize it is my responsibility to inform the Financial Aid Office of
any aid I receive that is not awarded to me by the Financial Aid or Admissions Office at New River Community and Technical
College.
Certifications and Signatures
Each person signing below certifies that all of the
information reported is complete and correct.
Print Student’s Name: ___________________________________ Student’s ID# __________________
Student’s Signature (Required): __________________________ Date: ________________
(Revised 06-11-2020)
WARNING: If you purposely give false or
misleading information, you may be fined,
sent to prison, or both.
click to sign
signature
click to edit
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