Financial Aid Office
(708) 709-3735
Fax: (708) 709-3716
m:\stuserv\favaoffice\2016-17 forms\lowincomedocumentstudent.docx
2016-17 Independent Low Income Document
To be completed by Student
Student’s Name ID#/SS#
The Office of Financial Aid is in the process of reviewing your request for financial aid and has found that additional
information is required in order to determine your eligibility. On the Free Application for Federal Student Aid (FAFSA) you
reported one of the following
No income reported in 2015;
Some or all of the income section on the FAFSA was left blank; or
You reported unusually low income that appears to be inconsistent with the number of family members
supported.
In the section below, list the 2015 yearly living expenses for your household. You will need to indicate your
yearly amount due, how much was paid, any amount paid by someone else, and who provided assistance. If this
section is left blank or lists all “$0’s” this form will be returned for completion and the process of your financial
aid will be delayed. Please carefully review the examples below to see how to properly report your information.
1. Mortgage and taxes or rent payment per month: Amount: $_____ x 12 = yearly amount: $_________
Who paid? student/spouse bill in student/spouse name but someone else gives money to pay
allowed to live in someone else’s residence for free
agency name:_________________________________________
2. Utilities (electric, heat, etc.): per month: Amount: $_____ x 12 = yearly amount: $_________
Who paid? student/spouse bill in student/spouse name but someone else gives money to pay
allowed to live in someone else’s residence for free
agency name:_________________________________________
3. Food: per month: Amount: $_____ x 12 = yearly amount: $_________
Who paid? student/spouse bill in student/spouse name but someone else gives money to pay
allowed to live in someone else’s residence and eat their food
agency name:_________________________________________
4. Transportation (gas, train, bus, etc.): per month: Amount: $_____ x 12 = yearly amount: $_________
Who paid? student/spouse bill in student/spouse name but someone else gives money to pay
allowed to use someone else’s vehicle
agency name:_________________________________________
5. Medical and dental costs: per month: Amount: $_____ x 12 = yearly amount: $_________
Who paid? student/spouse bill in student/spouse name but someone else gives money to pay
given free services from_________________________________
agency name:_________________________________________
6. Clothing/Other personal expenses: per month: Amount: $_____ x 12 = yearly amount: $_________
Who paid? student/spouse bill in student/spouse name but someone else gives money to pay
agency name:_________________________________________
Turn over to complete
