Financial Aid Request for At Home Child Care Allowance
2020-2021
You are requesting an adjustment to your cost of attendance. This adjustment is based upon your spouse being
unable to work in order to provide care for your child/children within your custody. If approved, the standard
allowance will be $700 per month regardless of the number of children in the household.
You must be able to demonstrate that your family would suffer a financial hardship if your spouse worked and
had to pay for child care. Please provide the information requested below.
Name: _________________________________________ Student ID#: ______________________
Indicate the term(s) YOU WILL BE ENROLLED when your spouse will be staying home to provide child
care.
Summer 2020 Fall 2020 Spring 2021
Please list YOUR dependents that your spouse will be caring for during the 2020-2021 aid year.
The dependents must have been included in your household size on your 2020-2021 FAFSA.
Child’s Full Name
Age
Child’s Full Name
Age
Children should be 12 years of age or under unless there is an extenuating circumstance.
Explanation of financial hardship if spouse worked outside of the home. Please include estimated cost of child
care if your spouse were to work outside the home.
All information provided is true and complete to the best of my knowledge. If requested by an authorized
official, I agree to provide additional documentation necessary to verify my request. I certify that I have read and
understand the requirements above.
Student’s signature Date
Spouse’s signature Date
SECTION A: STUDENT INFORMATION
SECTION B: ANTICIPATED ATTENDANCE
SECTION C: DEPENDENT INFORMATION
SECTION D: CERTIFICATION
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