Form - 2
Mail to: NCC Financial Aid
P.O. Box 7488
Rocky Mount, NC 27804
Number of Household Members and Number in College
(Dependent Student)
Name __________________________________________ Student ID ____________________________
List below the people in the parents’ household. Include:
The student.
The parent(s) (including a stepparent) even if the student does not live with the parents.
The parents’ other children if the parents will provide more than half of their support from July 1, 2020, through
June 30, 2021, or if the other children would be required to provide parental information if they were completing a
FAFSA for the 20202021 financial aid year. 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 parent(s) and the parent(s) provide more than half of their support and will
continue to provide more than half of their support through June 30, 2021.
For any household member, excluding the parents, who 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, include the name of the college.
If more space is needed, provide a separate page with the student’s name and NCC ID number at the top.
Full Name (Please Print)
Will be Enrolled at Least
Half Time
(Yes or No)
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.
Certifications and Signatures
Each person signing below certifies that all of the
information reported is complete and correct.
The student and one parent whose information was
reported on the FAFSA must sign and date.
________________________________________ ________________________
Print Student’s Name NCC Student ID Number
________________________________________ ________________________
Student’s Signature (Required) Date
________________________________________ ________________________
Parent’s Signature (Required) Date
WARNING: If you purposely give false or
misleading information you may be fined,
be sentenced to jail, or both.