Please initial each statement, sign and date the form where indicated.
I certify that I am the father mother of the dependent student named above.
(check one)
I stopped providing all nancial support (which includes paying any bills, providing room, board or any other
in-kind support) to the student as of .
month year
I certify that the student named above does not live with me.
I certify that the student named above is not included under my car or health insurance.
I certify that I did not claim the student named above as a dependent on my federal or other
income tax returns for 2017.
I certify that I will not claim the student named above as a dependent on my federal or other
income tax returns for 2017.
I refuse to complete the FAFSA for 2019-2020 for the student named above.
I understand that my refusal means the student named above will only be eligible for an unsubsidized loan.
Parent 1 Name (Print):
Parent 1 Signature Date
Parent 2 Name (Print):
Parent 2 Signature Date
Student Signature Date
Financial Aid Services
10901 Little Patuxent Pkwy
Columbia MD 21044
443-518-1260; 443-518-4576 (FAX)
TTY/STS use MD Relay
naid@howardcc.edu
www.howardcc.edu
CRI: FAC19ANS
ImageNow:
Doc type: UG Finaid Miscellaneous
FA Doc Name: MISC Corresp
Work Flow:
Main: FAS Document Processing
Sub-queue: Academic Year
B. CerticationandSignature
Each person signing below certies that all of the information reported is complete and correct.
A. Student’sInformation
Student’s Last Name Student’s First Name Student’s M.I. Student’s HCC ID Number
WARNING: If you purposely give false or misleading information, you may be ned, sent to prison, or both.
2 019/ 2 020 Parent Adavit of Non-Support
