Office of Financial Aid
323 Erie Street, P.O. Box 5015, Port Huron, Michigan 48061-5015
810-989-5530 fax 810-989-5774 sc4.edu
4/9/2020
2020-2021 Resources Form
Name _______________________________________ Student No. (SSN) _________________________
Email____________________________
This form has been requested because income reported on the FAFSA was blank, zero or appears to
be too low to have met basic living expenses for an individual or family.
Section A - In 2018 or 2019, did you, your parents or anyone in your parents’ household receive benefits from
any of the federal programs listed? Mark all that apply. Answering these questions will not reduce eligibility for
student aid or these programs.
Supplemental Security Income (SSI)
Supplemental Nutrition Assistance Program (SNAP)
Temporary Assistance for Needy Families (TANF)
Were you incarcerated during 2018? Yes (Please provide documentation) No
Section B - Student Section
Were you (and your spouse) required to file a 2018 federal income tax return (1040)? Yes No
If yes, please attach a copy of your 2018 signed IRS Tax Return.
Use the chart below to report your 2018 expenses and all forms of income received in 2018 from friends, relatives
and other resources that helped you pay these living expenses.
2018 expenses
Cost per month
($0 is not acceptable)
Who paid for it? (Work, parents, friends,
FIA*)
A) Housing (rent/mortgage)
$
B) Food
$
C) Other (clothing, medical, car)
$
D) Total 2018 living expenses per
month, Add lines A+B+C
$
E) Multiply line D x 12
Total 2018 living expenses
$
C. Parent Section- For Dependent Students
Were you (and your spouse) required to file a 2018 federal income tax return (1040)? Yes No
If yes, please attach a copy of your 2018 signed IRS Tax Return.
Use the chart below to report all 2018 expenses and forms of income received in 2018 from friends, relatives and other
sources that helped you pay for your living expenses.
2018 expenses
Cost per month
($0 is not acceptable)
Who paid for it? (Work, parents, friends,
FIA*)
A) Housing (rent/mortgage)
$
B) Food
$
C) Other (clothing, medical, car)
$
D) Total 2018 living expenses per
month, Add lines A+B+C
$
E) Multiply line D x 12
Total 2018 living expenses
$
Student ID:_______________
Rec’d by:_________________
Date:____________________
Office of Financial Aid
323 Erie Street, P.O. Box 5015, Port Huron, Michigan 48061-5015
810-989-5530 fax 810-989-5774 sc4.edu
4/9/2020
D. Certification: I (we) certify that the above information is true and accurate.
Student’s Signature _________________________________________________ Date _________________
Parent’s Signature __________________________________________________ Date _________________
If you are able, please print and physically sign this form. If you do not have access to print, please type your name above, but you
both will need to come into the Financial Aid office once we re-open to sign.
Submit this worksheet to the Financial Aid Office at SC4.
St. Clair County Community College
financialaid@sc4.edu
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