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Part 2: List all projected annual income and benefits from January 1, 2020 to December 31, 2020.
SOURCE OF INCOME (projected until end of the year) PARENT 1 PARENT 2 STUDENT
Wages, salaries, tips (including Severance Pay) $ $ $
Pensions and Annuities $ $ $
Interest and /or Dividend Income $ $ $
Business/farm Income $ $ $
Unemployment Compensation $ $ $
Alimony $ $ $
Social Security/SSI Benefits $ $ $
Workers Compensation $ $ $
Disability Benefits $ $ $
Retirement Benefits $ $ $
Child Support $ $ $
Welfare Benefits/ TANF $ $ $
Other Untaxed Income $ $ $
TOTAL INCOME
$ $ $
Part 3: Please complete the following chart by listing all people in your parent’s household. Include the name of the
college for any household member who will be enrolled at least half-time in a degree or certificate program at a
postsecondary educational institution any time between July 1, 2020 and June 30, 2021. If additional space is needed,
use an extra page. The definition of “household” includes:
Yourself, even if you don’t live with your parent
Your parent (including a step-parent) regardless of current marital status or gender
Your parent’s other children, even if they don’t live with your parent, if your parent will provide more than
half of their financial support from July 1, 2020 to June 30, 2021, or if the other children would be required to
provide parental information if they were completing a FAFSA for 2020–2021.
Other people who now live with your parent, if your parent provides more than half of their support and will
continue to provide more than half of their support through June 30, 2021.
STATEMENT OF CERTIFICATION
All of the information on this form is true and complete to the best of my knowledge. If requested, I agree to provide further
documentation to substantiate the information provided. I understand that all special circumstances are reviewed on a case-by-case
basis and this written request does not guarantee approval and/or may not ultimately result in an actual change to the financial aid
already offered. All persons providing information must sign below.
Student’s Signature ____________________________________________________ Date _______________________
(must be signed by hand, not typed)
Parent’s Signature _____________________________________________________ iDate _______________________
(must be signed by hand, not typed)
Full Name Age Relationship College (student will be enrolled at least half-time)
Self University of Maryland Global Campus
Parent 1
Parent 2
