2020–2021 Income and Expenses
The
income reported on your 2020
–2021 Free Application for Federal Student Aid (FAFSA) appears to be insufficient to meet basic living expenses.
The law says that before disbursing financial aid, we may ask you to confirm the information reported on the FAFSA. This purpose of this worksheet is to
determine how the basic needs of your household were met during the prior year. Please respond to each item. Indicate “0” (zero) or “N/A” if an item
does not apply to you. Your responses must be accurate and verifiable. Incomplete forms will not be processed. If you have any questions, contact
Financial Aid Services as soon as possible so that your financial aid will not be delayed.
A. Student’s Information
_______
_______________________________________________________
Student’s Last Name S
tudent’s First Name Student’s M.I.
_______
_______________________________________________________
Student’s Permanent Street Address (include apt. no.)
______________________________________________________________
City State Zip Code
______________________________________________________________
Student’s Home Phone Number (include area code)
XXX-XX-
Last 4 digits of Social Security Number
__________________________________
Student’s Date of Birth
__________________________________
Student’s Email Address
__________________________________
Student’s Cell Phone
Number
B. Household Expenses State the actual (or average) dollar amount paid per month in 2018 next to each expense item.
MONTHLY HOUSEHOLD EXPENSES 2018
AMOUNT PAID PER MONTH
1. Home Mortgage/Rental.............................................
$__________________________
2. Real Estate Taxes......................................................
$__________________________
3. Utilities (Phone, gas, heat, electric, water, etc.).......
$__________________________
4. Food and Household Supplies...................................
$__________________________
5. Automobile Payments................................................
$__________________________
6. Auto Insurance, Gas, Repairs and/or transportation..
$__________________________
7. Educational Expenses (excluding financial aid).......
$__________________________
8. Life and Health Insurance..........................................
$__________________________
9. Medical Expenses Not Covered By Insurance..........
$__________________________
10. Child Care/Day Care..................................................
$__________________________
11. Clothing.....................................................................
$__________________________
12. Credit Cards...............................................................
$__________________________
13. Miscellaneous............................................................
$__________________________
TOTAL MONTHLY EXPENSES
$
Please complete this form electronically, and then print, sign and return to Financial Aid Services
1
Per FAFSA, if you are an independent student, answer below as it
applied to your household in 2018 Be sure to include spouse
information if you are married.
Per FAFSA, if you are a dependent student, answer below as
it applied to your parent(s) household in 2018. Be sure to report
information for your parent as reported on the FAFSA.
Before responding below, consider the following definitions:
An independent student is one of the following: at least 24 years old, married, a graduate or professional student, a veteran, a member of the armed
forces, an orphan, a ward of the court, someone with legal dependents other than a spouse, an emancipated minor or someone who is homeless or at risk of
becoming homeless. A dependent student is someone who does not meet any of the criteria for an independent student. For questions regarding your
dependency status, please contact the financial aid office at finaid@moravian.edu or 610-861-1330.
Report information below in sections B. Household Expenses, C. Monthly Resources, and D. Other Information as it applies to your household in 2018.
2
Employer’s Name or Form of Income
20
18 Annual Amount Earned
Document Attached?
Susie’s Auto Body or Social Security Disability (example)
$2,050.00 (example)
Yes(example)
1._________
YES/NO Are/were any of y
our expenses on the previous page paid by another person? If YES, please explain below:
_____________________________
________________________________________________________________________________
________
_______________________________
______________________________________________________________________________
E. Certification and Signatures
Each p
erson signing
below
certifies that all of the information
r
eported is complete and correct.
_
_
_______________________________________________
Student
S
ignature
(signature required)
_________________________________________________
Parent
Signature (if dependent student) OR
Spouse Signature
(if independent and married)
_
________________________________
Date
______
___________________________
Date
WARNING: If you pur
posely give false or misleading
information on this worksheet, you may be fined, sent
to pr
ison, or both.
was not employed and had no income
earned from work
was employed and had earnings*
received some other type of income/
resource*
was not employed and h
ad no income
earned from work
was employed and had earnings*
received some other type of income/
resource*
were not employed and had no
income earned from work
were employed and had earnings*
received some other type of income/
resource*
*
Please list all income and other resources (by name/type and dollar amount earned) that were used to meet the monthly
expenses listed on the
previous page.
Be sure to list every employer or resource,
even if
an employer or resource did not issue an IRS
W-2 form or other form. For
each
source for which you have documentation, please provide the document(s) confirming the income/resource and dollar amount. (Examples of
acceptable documents: W-2 forms, social security statements (SSI, SSDI), unemployment statements, child support documentation, bank
statements, etc.)
In 2018, one or both of the
dependent student's parent(s):
In 2018, the independent
student's spouse (only if married):
boyfriend, girlfriend, etc.)? If YES, please explain below:
2.
YES/NO Are/were
you
residing with or supported by another person (e.g., your
parent, relative, friend,
C. Monthly Resources
Complete this section if the independent student (and spouse if married) or dependent student's p
arent(s) will not file and are not required to file a
2018 income tax return with the IRS.
If
the student is an independent student and is not married, the instructions and certifications below apply to the student only.
If the student is an independent student and is married, the instructions and certifications below apply to the student and the student's spouse.
If the student is a dependent student, the instructions and certifications below apply to each parent included in the household.
Check the boxes that apply:
I
n
2018, the independent student
(regardless of marital status):
D.Other Information
If the student was required
to provide parent information on the FAFSA, answer each question below as it applies to the student’s parent(s) whose
information is on the FAFSA. If the student was not required to provide parent information on the FAFSA, answer each question below as it
applies to the student (and the student’s spouse, only if married).
Please return your completed form to the Office of Financial Aid Services via:
Mail (1200 Main Street Bethlehem, PA 18018)
Electronically though Xmedius SendSecure
Fax (610-861-1346)
In-person (1st floor Colonial Hall)
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