Name of Recipient
Type of
Resource
Annual Amount of Support
Received in 2018
Total Amount of Support Received $
Did you (and/or your spouse if married) live with someone who provided
housing
during 2018?
Yes No
Do you have children or other dependents for whom someone other than you (and your
spouse if married) provided more than half their support during the school 2019-20 year or will
provide during the 2020-21 school year?
Yes No
Did you (and/or your spouse if married) file a U.S. or foreign tax
return for the 2018 tax year?
Yes No
Did you (and/or your spouse if married) earn income the U.S. during 2018?
If
YES, how much was earned for the year.
Yes
No
$
Did you (and/or your spouse if married) live in another country during 2018? If YES,
In which country did you (and/or your spouse if married) live during 2018?
Yes
No
Name of Country:
Did you (and/or your spouse if married) earn income outside the U.S. during 2018?
If
YES, how much was earned for the year, converted to U.S. dollars?
Yes
No
$
Did you or any member of your household receive any resources such as housing assistance, SNAP,
TANF, SSI, SSDI, or other benefit? If YES, complete the information below.
Yes No
Section A: Student Information
MC ID#: ________________ Last Name: ___________________________ First Name: ____________________
Office of Student Financial Aid
Phone : (240)567-5100
Email:FinancialAid@montgomerycollege.edu
Office use only Code: IHRESO/ FA HH RES IND ODD
2020-2021 Independent Household Resource Form
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Did you (and/or your spouse if married) receive child support during 2018 tax year? If
YES, how much was received for the year?
Yes No
$
Section B: Instructions
You (and your spouse if married) must complete this form and return it and any other requested documents to
the
Montgomery College Office of Student Financial Aid (OSFA). You are being asked to complete this form because the
income information you (and/or your spouse if married) reported on your FAFSA does not seem to support the number of
people you have reported as part of your household. Upon review, we may ask for additional information and/or ask you to
update information on your FAFSA.
Answer each question below as it applies to the student (and the student’s spouse, if married) whose information is on the
FAFSA.
All questions must be answered.
PLEASE COMPLETE ALL SECTIONS OF THIS FORM BEFORE SUBMITTING IT WITH ALL OTHER REQUESTED DOCUMENTS TOGETHER
PRINT
Purpose
Source
(Name of person or agency)
Annual Amount
Received in 2018
Total Amount of Support Received $
II / We understand
that this form must be signed and submitted with all other requested documents before my
financial aid will be processed. Each person signing below certifies that all of the information reported is complete and
correct.
Electronic signatures are not acceptable.
WARNING: If you purposely give false or misleading information, you may be fined, sent to prison, or both.
Date:
Student Signature:
Spouse Signature:
Date:
Did you (and/or your spouse if married) have any money paid on your behalf (e.g., payment
of your bills) and not reported
elsewhere on this form. Include support from a
parent whose
information was not reported on the student’s 2020-21 FAFSA. For example, if someone is
paying
rent, utility bills, etc., for the student or gives cash, gift cards, etc., include the amount
of that person's contributions.
If
YES,
enter below
the total amount of cash support the
student received in 2018.
Yes No
S
ection D: Comments
If you have an additional explanation, means of support and or resources not listed anywhere else on this form, you
must explain it here. In Section C, if you answered "No"and entered "Zeros" to all questions, you must explain how
you were financially supported below:
_________________________________________________________________________________________________
_
_________________________________________________________________________________________________
_
_________________________________________________________________________________________________
_
_________________________________________________________________________________________________
_ ________________________________________________________________________________________________
Section E: Certification
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Rent
Food/Grocery
Utility Bills
Transportation
Cash
Other
2020-2021 Independent Household Resource Form
Section C: 2017 Household and Resource Information (continued)
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