Academic Year: 2020-2021 Form: Confirmation of Household Member Dependent
Student’s ID #: Student’s Name: ______________________________
Please scan and submit this completed form at www.umgc.edu/help/submit-case.cfm.
F21HMD
Your 2020-2021 Free Application for Federal Student Aid (FAFSA) was selected for a process calledverification”,
in which UMGC is required to confirm the information you and your parent(s) reported on the FAFSA. Accurate
completion of this form is required in order to verify and process your 2020-2021 financial aid application.
According to Federal Student Aid regulations, only the following persons are considered members of your
economic household as a dependent student:
yourself, even if you don't live with your parents;
your parents;
your parents’ other children (even if they do not live with your parents) if your parents will provide more
than half of
their support between July 1, 2020 and 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 if they now live with your parents, your parents provide more than half of their support, and your
parents will continue to provide more than half of their support between July 1, 2020 and June 30, 2021.
Instructions: For anOther Person” (as defined above) to be included in your household size, your parent
must attest to the following and complete all sections of this form. If the person in question does not
meet the criteria for inclusion, be sure to select the "WILL NOT" option when completing the next section.
A separate form must be submitted for each person for whom confirmation has been requested.
I, the student's Parent, certify that I {select one} WILL WILL NOT provide more than
half of the financial support for the person listed below from July 1, 2020 through June 30, 2021.
_____________________________________________________________________________________________ Name
of Person
________________________________________________________________________________
Relationship to me, the Parent
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.
Student’s Signature ____________________________________________________ Date _______________
(must be signed by hand, not typed)
Parent’s Signature _____________________________________________________ Date _______________
(must be signed by hand, not typed)
UMGC Office of Financial Aid | 3501 University Boulevard East, Adelphi MD 20783 USA
___________
Age
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