Financial Aid
Student’s Name:
Student ID:
Date of Birth:
Academic Year (To be entered by FAO only):
On your Free Application for Federal Student Aid, you either did not provide income information or you provided income
information that seems unusually low.
Using this form, please indicate how you provided for yourself (and your family if applicable); or if this form is for your
parents, how they provided for themselves. If an agency or family/friend provided assistance for you or your parents,
then please identify who is helping you (or helped you last year) and how much they are providing for you (or provided
for you last year) on a
monthly basis.
If you are not receiving cash benefits, then please indicate the amount of monthly assistance you are receiving for the
following items. For example, if your friend or family member pays $600 in rent and there are four people living in the
apartment, including you, then your share of the rent that is being paid on your behalf would be $150 per month.)
Some items may not apply.
Rent/Mortgage $
Utilities $
Food $
Transportation (Auto) $
Other (Specify) $
Other (Specify) $
Total $
Student’s Signature and Date
Parent’s Signature and Date
(Required for Dependent Students Only)
FAO Comments Only:
IRSC is an EA/EO educational institution.
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