* This form must be submitted by the priority deadline to ensure a determination of eligibility before the Fee Due Date. Students may still apply
for aid after the priority deadlines, but EFSC cannot guarantee that late submissions will be notified of aid eligibility prior to the Fee Due Date.
01/22/20
21LD
FA Verification
2020-21 Legal Dependents Form
You included dependent(s) in your household on your Free Application for Federal Student Aid (FAFSA).
This form is required to determine if the individuals you listed meet the definition of dependent household members.
Complete a separate form for each dependent you included on your FAFSA.
Priority Deadlines*: Fall 202007/23/20 | Spring 2021 – 11/30/20 | Summer 2021 – 04/22/21
A. Student Information
B#
Last Name First Name M.I. Student ID
B. Dependent in Your Household
Federal financial aid regulations define “dependents” as children or other persons who live in your household and
will receive more than 50% of their living expenses and other financial support from you between July 1, 2020 and
June 30, 2021.
Name of Dependent:
Age of Dependent:
Relationship to Student:
1. Will you provide more than 50% of the support to this individual from July 1, 2020 to June 30, 2021?
YES Go to Question 2.
NO Skip to Section D to sign the form. This person does not belong in your household and will be
excluded during the verification process.
2. Will this person continue to live at the same address as you until June 30, 2021?
YES Complete Section C.
NO Skip to Section D to sign the form. This person does not belong in your household and will be
excluded during the verification process.
3. I filled out the FAFSA incorrectly.
I do not have dependents. Skip to Section D to sign the form.
You will need to report parental information on the FAFSA. Please speak with a Financial Aid Specialist if
you have questions about your next steps.
EFSC Office of Financial Aid
www.easternflorida.edu/go/aid | (321) 433-7339 | finaid@easternflorida.edu
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C. Income Sources
Report all income sources received by the dependent. Do not leave any income source blank. If the dependent does
not
receive income from the listed source, put a "0" (zero).
Source of Income
Amount of Income
Temporary Assistance to Needy Families (TANF)
Amount received per month
Social Security
Amount received per month
Income from Work
Amount received per month
Unemployment Benefits
Amount received per month
Financial Aid (grants, loans, & scholarships) in excess of tuition and fees
Estimated monthly amount to be received in 2020-21:
Other sources of income (please specify):
Amount received per month
TOTAL
D. Certification 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.
Student’s Original Signature (cannot be signed electronically) Date
WARNING: If you purposely give false
or misleading information, you may be
fined, sent to prison, or both.
EFSC Office of Financial Aid
www.easternflorida.edu/go/aid | (321) 433-7339 | finaid@easternflorida.edu
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E. Document Submission
You may submit this document by the following methods:
1. EFSC DOCUMENT DROPBOX (RECOMMENDED)
Print and complete this document (including the original signature), scan the document, and upload the
document via the Document Dropbox in myEFSC. Printers and scanners are available in EFSC’s open
computer labs and libraries.
2. IN PERSON
Submit your document in person at the Office of Financial Aid on any campus:
Cocoa
Building 11, Room 209
Monday through Thursday, 8 a.m. to 7 p.m.
Building 1, Room 117
Melbourne
Building 1, Room 137
Monday through Thursday, 8 a.m. to 7 p.m.
Building 3, Room 125
Monday through Wednesday, 8 a.m. to 5:30 p.m.
3. BY MAIL
Mail your document to the Office of Financial Aid on any campus:
Cocoa
Eastern Florida State College
Office of Financial Aid, C11-209
1519 Clearlake Road
Cocoa, FL 32922
Palm Bay
Eastern Florida State College
Office of Financial Aid, PB1-117
250 Community College Parkway
Palm Bay, FL 32909
Melbourne
Eastern Florida State College
Office of Financial Aid, M1-137
3865 N. Wickham Road
Melbourne, FL 32935
Titusville
Eastern Florida State College
Office of Financial Aid, T3-125
1311 N. US 1
Titusville, FL 32976
QUESTIONS?
Financial Aid Specialists are available at the campus locations listed above, by phone at 321-433-7339, and via e-mail at
finaid@easternflorida.edu.
Eastern Florida State College is committed to equal access/equal opportunity in its programs, activities, and employment. For
additional information, visit Eastern Florida State College:
easternflorida.edu/go/equity.
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