2019–2020 Dependent Household Information Form
Your FAFSA was selected by the U.S. Department of Education for a process called verification. BRCC is required by federal law
to compare the FAFSA with the information on this worksheet. You, your parent, and if married parent’s spouse, must complete
this form. You and your parent must sign and submit the form to the Financial Aid Office to determine eligibility for federal student
aid. Incomplete forms or conflicting information will cause delays in the processing of your aid. Instructions for looking
up your Student I.D. can be found here: Find your student ID here.
A. Student Information:
Last Name: _______________________________________ First Name: _________________________________________
Student ID (required): _________________ Date of Birth: ___________________ Phone Number: ____________________
B. Household Members and Number in College
Complete the below statement and list the people in your parent(s)’ household. If anyone in the household, not including your
parent(s), will be enrolled in at least 6 credits at an eligible postsecondary institution/program any time between July 1, 2019 and
June 30, 2020, include the name of the college. If more space is needed attach an additional sheet with the student’s name and
ID at the top. The student and parent must sign and date the additional sheet.
Household members include the following:
Yourself
Your parent(s), including a stepparent, even if you do not live with your parent(s).
Your parent(s)’ other children if your parent(s) will provide more than half of their support from July 1, 2019 through June 30, 2020, or if the other
children would be required to provide parental information if they were completing a 2019-2020 federal financial aid application. Include children
who meet either of these descriptions, even if they do not live with your parent(s).
Other people if they now live with your parent(s) and your parent(s) provide more than half of their support and will continue to provide more than
half of their support through June 30, 2020.
Total Number of people in your household: _______ Total Number of people in your household attending college in 2019-2020: _______
C. Certification and Signatures
Each person signing below certifies that all the information reported on this worksheet is complete, correct, and any additional information is attached.
The student and one parent MUST sign and date this section in blue or black ink.
WARNING: If you purposely give false or misleading information on this worksheet you may be fined, sentenced to jail, or both.
Student Signature: _____________________________________________________________ Date: _______/_______/_______
Parent Signature: ______________________________________________________________ Date: ______/_______/________
Please return this completed form in one of the following ways: upload it using the link to the form on your To-Do list in SIS, fax
to 540-234-8189, scanned e-mail attachment to finaid@brcc.edu, or mail to Blue Ridge Community College, Office of Financial
Aid, Box 80, One College Lane, Weyers Cave, VA 24486. Please call 855-844-3631 if you have questions.
