Fillable EOP HOUSEHOLD SUPPORT WORKSHEET FOR DEPENDENT STUDENT 2018 (State University of New York at Plattsburgh)

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EOP HOUSEHOLD SUPPORT WORKSHEET FOR DEPENDENT STUDENT 2018 (State University of New York at Plattsburgh)

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Financial Aid Office • SUNY Plattsburgh • 101 Broad Street • Plattsburgh, NY 12901-2681
Tel: (518) 564-2072 • Toll-Free: (877) 768-5976 • Fax: (518) 564-4079 • email: finaid@plattsburgh.edu
Revised: 12/01/2019 YHSUPP
EOP HOUSEHOLD SUPPORT WORKSHEET FOR DEPENDENT STUDENT 2018
Student Name: ___________________________ Banner ID or NetID: ____________________________
On your EOP Application you indicated that your household has zero ‘0’ income or an income that appears too
low to support the number of household members you have reported. Please use the form below to clarify
your household’s financial support for 2018: between January 1, 2018 and December 31, 2018. This
information is necessary in establishing your financial eligibility for EOP.
Complete all items. If items are left blank, this form will not be processed.
Child support received (total annual amount)
☐ Yes ☐ No
Amount per year: $
Alimony received
☐ Yes ☐ No
Amount per year: $
SNAP (formerly known as food stamps)
☐ Yes ☐ No
Amount per year: $
Home energy assistance
☐ Yes ☐ No
Amount per year: $
Housing Assistance
☐ Yes ☐ No
Amount per year: $
TANF (
“Family Assistance or “Safety Net Assistance”
)
☐ Yes ☐ No
Amount per year: $
Free/Reduced school lunch
☐ Yes ☐ No
Amount per year: $
Recipient:
Relationship to applicant:
Unemployment income
☐ Yes ☐ No
Amount per year: $
Recipient:
Relationship to applicant:
Social Security Disability (SSD)
☐ Yes ☐ No
Amount per year: $
Recipient:
Relationship to applicant:
Supplemental Security Income (SSI)
☐ Yes ☐ No
Amount per year: $
Recipient:
Relationship to applicant:
Survivors Benefits
☐ Yes ☐ No
Amount per year: $
Recipient:
Relationship to applicant:
Military and Veteran’s Benefits
☐ Yes ☐ No
Amount per year: $
Recipient:
Relationship to applicant:
“Gifts” from family, friends or community
☐ Yes ☐ No
Amount per year: $
OTHER
☐
Yes
☐
No
Please attach a statement detailing your household
circumstances.
For any benefits that you reported below, attach a letter or summary statement from the agency that
provides the benefits. Attachments must verify the annual amounts reported above for 2018.
By signing this worksheet, I certify that all the information reported is complete and accurate. If false or
misleading information is purposely provided on this worksheet, I understand that my application or acceptance
to EOP will be revoked.
Student Ink Signature Date
Parent Ink Signature If Dependent Date
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EOP HOUSEHOLD SUPPORT WORKSHEET FOR DEPENDENT STUDENT 2018 (State University of New York at Plattsburgh)

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Completed 24 July 2020

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