UNIVERSITY OF NORTHERN COLORADO
CARTER HALL 1005, CAMPUS BOX 33, GREELEY, CO 80639-0055 Office 970-351-2502 Fax 970-351-3737
www.unco.edu/ofa
Affidavit of Legal Dependent(s) 2020-2021
_______________________________________
Student Name (Please Print) Bear Number
On your Free Application for Federal Student Aid (FAFSA) you answered “yes” to the question:
Do you now or will you have children who will receive more than half of their support from you between July 1, 2020 and June 30, 2021?
OR
Do you have dependents (other than your children or spouse) who live with you and who receive more than half of their support from you,
now and through June 30, 2021?
Support for your children or dependent(s) includes housing, food, clothing, medical (dental care), childcare, money, gifts, etc. that you provide.
Resources that enable you to provide the support can include: (1) Earnings you receive from work or in-kind support (housing/food in exchange for
work), (2) Assistance you receive from other agencies (such as Medicaid, Temporary Assistance for Needy Families, and SNAP). Money you receive
from your parent(s) cannot be included as a resource for your dependents’ support.
Complete Chart A if you have children who will receive more than half of their support from you between July 1 and June 30 of the award year. List
your dependents and complete the certification at the bottom of this form.
NAME OF CHILD(REN)
(If child is unborn, attach a statement
from a physician with a projected
date of birth)
RELATIONSHIP TO
YOU THE STUDENT
(son, daughter, stepson,
stepdaughter, etc.)
LIST THE CHILD(REN)’S OTHER PARENT AND NAME OF
COLLEGE IF APPLCIABLE
Complete Chart B if you have dependents (other than your children or spouse) and if at the time you completed your FAFSA they a) lived with you
and received more than half their support from you and b) will continue to receive more than half their support from you through then end of the
award year. List your dependents and complete the certification at the bottom of this form.
NAME OF DEPENDENT
(other than your child)
RELATIONSHIP TO
YOU THE STUDENT
INDICATE THE DATE HE/SHE BEGAN LIVING WITH YOU
Certification (check appropriate box)
☐ I attest I do provide more than half of the support for the dependent(s) listed in chart A or B. By checking this box, I also certify the dependent(s)
in chart A or B lived with me at the time I completed the FAFSA and will continue to live with me between July 1 and June 30 of the award year and I
will provide more than half of their support.
☐ I answered incorrectly and none of these conditions applies to me. By checking this box, I understand that I will need to return this form to
Student Financial Services and correct my FAFSA by adding parental information.
By signing below, I certify all information provided on this form is complete and correct.
______________________________ _______________________________________
Student Signature Date
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signature
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