Fillable Dhrese Dependent Household Resource

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Dhrese Dependent Household Resource

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2019-2020 Dependent Household Resource Form
Name of Recipient
Type of
Resource
Annual Amount of Support
Received in 2017
Total Amount of Support Received $
Did your parent(s) live with someone who provided housing during 2017?
Yes
No
Did you and/or your parent(s) file a U.S. or foreign tax return for the 2017 tax year? If YES,
you must correct the FAFSA parent and or student income section(s).
Yes No
Did you and or your parent(s) earn income in the U.S. during 2017? If YES, how much
was earned for the year?
Yes
No
$
Did your parent(s) live in another country during 2017?
If YES, in which country did your parent(s) live during 2017?
Yes
No
Name of Country:
Did your parent(s) earn income outside the U.S. during 2017?
If YES, how much was earned for the year, converted to U.S. dollars?
Yes
No
$
Did you or any member of your household receive any resources such as housing assistance,
SNAP, TANF, SSI, SSDI, or other benefit? If YES, complete the information below.
Yes
No
Section A: Student Information
MC ID#: ________________ Last Name: __________________________ First Name___________________
Section B: Instructions
You and at least one parent must complete this form and return it and any other requested documents to the
Montgomery College Office of Student Financial Aid (OSFA). You are being asked to complete this form because the income
information you and your parent(s) reported on your FAFSA do not seem to support the number of people you have reported as
part of your household. Upon review, we may ask for additional information and/or ask you to update information on your
FAFSA.
Answer each question below as it applies to the student and the student’s parent(s) whose information is on the FAFSA.
All questions must be answered.
PLEASE COMPLETE ALL SECTIONS OF THIS FORM BEFORE SUBMITTING IT WITH ALL OTHER REQUESTED DOCUMENTS TOGETHER
Office of Student Financial Aid
Phone : (240)567-5100
Email: Financia
lAid@montgomerycollege.edu
M
Office use only Code: DHRESE / FA HH RES DEP EVEN
Page 1
Yes
Did you and or your parent(s) receive child support during 2017? If YES, how much
was received for the year?
No
$
Section C: 2017 Household and Resource Information
0.00
PRINT
Purpose
Source
(Name of person or agency)
Annual Amount
Received in 2017
Total Amount of Support Received $
Date:
Electronic signatures are not accepted (must be signed in ink).
Student Signature:
Parent Signature:
Date:
Did you or your parent(s) have any money paid on the family’s behalf (e.g., payment
of bills) and not reported
elsewhere on this form. Include support from relatives
whose information was not reported on the student’s 2019-20 FAFSA. For example,
if someone is paying
rent, utility bills, etc., or gives cash, gift cards, etc., include the
amount of that person's contributions.
If
YES,
enter below
the total amount of cash
support received in 2017.
Yes
No
S
ection C: 2017 Household and Resource Information (continued)
Section D: Comments
If you have an additional explanation, means of support and or resources not listed anywhere else on this form, you
must explain it here. In Section C, if you answered "No"and entered "Zeros" to all questions, you must explain how you
were financially supported below:
_________________________________________________________________________________________________
_
_________________________________________________________________________________________________
_
_________________________________________________________________________________________________
_
_________________________________________________________________________________________________
_
_________________________________________________________________________________________________
_ ________________________________________________________________________________________________
Section E: Certification
We certify that all the information contained on this form is complete and correct. NOTE: If you purposely give false
or misleading
information, you may be imprisoned and/or fined up to $25,000. I / We understand that this form must
be signed and submitted with
all other requested documents before the student’s financial aid will be processed.
M
2019-2020 Dependent Household Resource Form Page 2
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Dhrese Dependent Household Resource

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Completed 7 April 2020

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