Dependent Household Information Form 2021-2022
For Office Use Only:
Checklist Item:
9DHI22
COMMKEY
9DHI
Your FAFSA was selected for verification. The information on this form is required to process your application for financial aid for
the 2021-2022 academic year. To allow time for processing, return the completed and signed form no later than two weeks prior to
your last date of attendance for the 2021-2022 academic year.
Federal Financial Aid Awards will not be processed and/or disbursed until all required verification documents are reviewed and
completed. All documents submitted after the deadline may jeopardize eligibility for Federal Financial Aid, and will only be reviewed
for Pell Grant eligibility. Federal Direct Loans cannot be certified or processed after your last date of attendance for the academic
year.
Who is considered a parent for purposes of this form?
Grandparents, foster parents, and legal guardians are NOT considered parents on this form unless they have legally adopted you.
Your legal parents include biological, adoptive, or as determined by the state [for example, if the parent is listed on the birth
certificate].
If your legal parents are married to each other, include them both in the household section and base this form on their
household.
If your legal parents are not married (including legally divorced or separated), but are living together, include them both in the
household section and base this form on their household.
If your parent is widowed or single, include this parent in the household section and base this form on his/her household. If your
widowed parent is remarried as of the day you completed the FAFSA, include the parent and the person whom your parent
married (your stepparent).
If your parents have divorced or separated, and do not live together, only include in the household section the parent you lived
with more during the past 12 months and base this form on his/her household. (If you did not live with one parent more than
the other, only include the parent who provided more financial support to you during the last 12 months, or during the most
recent year that you actually received support from a parent, and base this form on his/her household.) If this parent has
remarried as of the day you completed the FAFSA, include that parent and the person whom your parent married (your
stepparent).
Whom to include from your parents’ household (in Section A of this form):
Yourself and your parents/stepparent; (see above for definition of parent), even if you have moved out your parents' home; and
Your parents’ other children, even if they don’t live with your parents, if:
1. Your parents will provide more than half of their support from July 1, 2021, through June 30, 2022, or
2. The children would be required to provide parental information when applying for federal student financial aid; and
Other people if they now live with your parents, and your parents provide more than half of their support and will continue to
provide more than half of their support from July 1, 2021, through June 30, 2022.
You must physically sign this form as typed signatures are not acceptable.
For secure and faster processing, submit this form via the Upload Process located in your SOLAR To Do List.
Need help scanning your document? Check out our Scanning Documents Using Your Smartphone guide.
Note: Only .tif and/or .pdf file types are allowed for uploading.
Alternatively, mail or fax all documents to the appropriate financial aid department listed below. Be sure to include the student’s name and Stony
Brook ID on all correspondence.
Schools of Nursing, Social Welfare, Health Technology and
Management, and the Graduate Programs in Public Health and
Nutrition:
All Other Graduate and Undergraduate Programs
Health Sciences Office of Student Services
Health Sciences Tower Level 2, Room 271
Stony Brook, NY 11794-8276
Telephone: 631-444-2111
Fax: 631-444-6035
Office of Financial Aid and Scholarship Services
Stony Brook Union, Suite 208
Stony Brook, NY 11794-3252
Telephone: 631-632-6840
Fax: 631-632-9525
Dependent Household Information Form 2021-2022
For Office Use Only:
Checklist Item:
9DHI22
COMMKEY
9DHI
__________________________________________________ _____________________________________
Student’s Name: Last First M.I. Stony Brook ID#
__________________________________________________ ______________________________________
Address: (number, street, city, state, zip) Student’s phone number
Section A Household Information (if more space is needed, continue list on a separate sheet):
Complete the information below according to the number of people in your parents’ household in 2021-2022.
*Required information/ Do not leave blank
List all people that should be included in your
parent’s household, starting with yourself. You must
include your parent(s), his or her spouse (if
married), and any children or dependents living in
the home if your parent(s) will provide more than
half of their support from July 1, 2021 through June
30, 2022.
*Relationship to
Student
Will family member be
enrolled in a degree
program at a
college/university at
least ½ time in
2021/2022?
Name of College/University
See instructions on page 1 for information on whom to list (begin with student)
Self/Student
o Yes
o No
Stony Brook University
o Yes
o No
o Yes
o No
o Yes
o No
o Yes
o No
o Yes
o No
*If you listed a family member above, who is not a dependent on your parent’s tax return (excluding siblings or parent’ of the student).
Explain the reason below:
________________________________________________________________________________________________________________________
You must physically sign this form as typed signatures are not acceptable.
Section B Certification and Authorization: Do NOT submit this form without ALL required signatures. By signing this form, we
certify that all the information reported is complete and correct. (Note: Student and at least one parent must sign).
____________________________________________________ _________________________________________________
Student’s Signature Date Parent’s Signature Date
For secure and faster processing, submit this form via the Upload Process located in your SOLAR To Do List. Emailed forms will not be accepted.
Need help scanning your document? Check out our Scanning Documents Using Your Smartphone guide.
Note: Only .tif and/or .pdf file types are allowed for uploading.