2017-2018 Verification of Household Members and/or Marital Status
Blue Ridge Community College
Instructions:
Complete this form and submit it to the Financial Aid Office as soon as possible, so that your financial aid won’t be delayed. The Financial Aid Office
can assist you if you have questions. Incomplete forms will be returned unprocessed. If you do not know your Student ID number, instructions for
looking it up can be found at https://www.brcc.edu/services/computing/mybrcc-support/index.html#emplid
Last Name: ____________________________ First Name: ________________________ Middle Initial: _________
Student ID: ________________ Date of Birth (MM/DD/YY): _________________ Phone Number w/Area code: _____________
Household Members:
Total Number of people in your household: _______ Total Number of people in your household attending college in 2017-2018: _______
For the above question, indicate the number of people in your household, including;
Yourself,
For dependent students: Parents (even if you do not live with them) and any dependent siblings,
For independent students: Spouse and any children or other dependents,
Other people if they now live with your family, and your family provides more than half of their support and will continue to provide more
than half of their support from July 1, 2017 through June 30, 2018.
Indicate the number of household members who will be attending college between July 1, 2017 and June 30, 2018. Only include family members
who are attending at least half-time in a degree or certificate program. Do not include your parents.
Student Marital Status Verification:
Please indicate your marital status:
☐ Single ☐ Married ☐ Divorced/Separated ☐ Widowed
Date of marital status: __________________
Please indicate your tax filing status:
☐ Single ☐ Married Filing Separately ☐ Married Filing Jointly ☐ Head of Household ☐ Will Not File
Parent Marital Status Verification:
Please indicate your parent’s marital status:
☐ Single ☐ Married ☐ Divorced/Separated ☐ Widowed
Date of marital status: __________________
Please indicate your parent’s tax filing status:
☐ Single ☐ Married Filing Separately ☐ Married Filing Jointly ☐ Head of Household ☐ Will Not File
Signature:
By signing this worksheet, you certify that all the information is complete and correct. You must physically sign this form.
Student Signature: ________________________________ Date Signed: ____/_____/_________
Parent Signature: _________________________________ Date Signed: ____/_____/_________
Please return this form by fax to 540-234-8189, scanned e-mail attachment to finaid@brcc.edu
, or mail to Blue Ridge Community College,
Office of Financial Aid, Box 80, One College Lane, Weyers Cave, VA 24486. Please call 855-844-3631 if you have questions.
