Household Certification Form
2017-2018
Your financial aid application (2017-2018 FAFSA) has been selected for review. Please provide us with the information that is
requested below within 30 (thirty) days to finalize your eligibility for aid.
Student’s Name
Student ID #
Last First MI
Permanent Address
Street Address City State Zip
SSN (optional) ________________________ Home Phone ______________________ Cell Phone __________________
Dependent Students: List the people within your parents’ household for whom your parent(s) will provide at least half of their support*
between July 1, 2017 and June 30, 2018. Include the following:
Yourself (even if you do not live with your parents) and
Your parent(s) and
Your parent(s)’ other children and
Other people if they now live with your parents and your parents provide more than half of the other person’s support, and will
continue to provide more than half of that person’s support through June 30, 2018;
Independent Students: List the people within your household for whom you will provide at least half of their support* between July 1,
2017 and June 30, 2018. Include the following:
Yourself and your spouse (if you have one) and
Your children and
Other people if they now live with you and you or your spouse provides more than half of the other person’s support, and will continue
to provide more than half of that person’s support through June 30, 2018.
* Support includes money, gifts, loans, housing, food, clothes, car, medical and dental care, payment of college costs, etc.
Also, please indicate in the space below if a household member will be enrolled in college at least half-time in a degree, diploma or certificate
program at an eligible postsecondary educational institution any time between July 1, 2017 and June 30, 2018, by listing the name of the
college and grade level.
Please read guidelines above before completing. Attach extra page if needed.
College Name/Grade Level for 2017-2018
I (We) hereby affirm that all information reported on this form and any attachment hereto is true, complete, and accurate to the best of
my (our) knowledge. I (We) understand that if I (we) receive federal student aid based on incorrect information, I (we) will need to repay
it; I (we) may be required to pay fines and fees.
Student _____ Date
_____________________________
Parent (if dependent) _____ Date
_____________________________
Office of Financial Aid
300 College Park
Dayton, Ohio 45469-1605
FAX: 937-229-4338
www.finaid.udayton.edu
