FINANCIAL AID OFFICE
2020-2021 Student Status
185 Freedlander Drive | Clyde, NC 28721 | 828.627.4756 or 1.866.GoToHCC | fax: 828.627.4513 | email@example.com
Students under the age of 24 who have dependents, e.g., children or other than a spouse, for whom they provide more than half of their
support between July 1, 2020 and June 30, 2021 may not be required to provide parental information on their Free Application for Federal
Student Aid (FAFSA). Student should return this completed form with the required documentation to the Financial Aid Office (FAO) and
contact the FAO to determine if he/she meets the requirements for this determination. If you have questions, please contact the FAO
promptly to avoid delays in the processing of your financial aid.
Last Name First Name M.I. HCC ID # or SSN (last 4 digits)
Street Address (include apt. no.) Date of Birth
City State Zip Code Email Address
Home Phone Number (include area code) Alternate or Cell Phone Number
1. Do you have children or other dependents who receive MORE THAN HALF of their support from you and will
continue to receive support from you between July 1, 2020 and June 30, 2021? □ YES □ NO
A. If YES, please list name, age, and relationship of dependents: ______________________________________________
2. Select your housing status and attach the required documentation (in italics):
□ I and my children/dependents live in housing provided by me.
*Provide a copy of the lease/mortgage listing you as renter/owner.
□ I and my children/dependents live in housing provided by someone else. List the name and relationship of the person
providing the housing: __________________________________________________________________________________
*Attach a signed statement from this person indicating the amount of rent paid and how often.
A. List name, age, and relationship of all occupants: _______________________________________________________
3. Calculate your monthly expenses and attach copies of the REQUIRED documentation:
Utility bills and other monthly expenses (indicated below) with your name and address
Current paycheck stubs
Documentation of all other sources of income/benefits including Supplemental Security Income (SSI), Food Stamps (SNAP),
Medicaid/Medicare, Special Supplemental Nutrition Program for Women, Infants & Children (WIC), or Temporary
Assistance for Needy Families (TANF)