Financial Aid Office
(708) 709-3735
Fax: (708) 709-3716
m:\stuserv\favaoffice\2016-17 forms\lowincomedocumentparent.docx
2016-17 Dependent Low Income Document
To be completed by your parents
Student’s Name ID#/SS#
The Office of Financial Aid is in the process of reviewing your son/daughter’s request for financial aid and has found that
additional information is required in order to determine his/her 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 your 2015 yearly living expenses. You will need to indicate your yearly amount due,
how much was paid, any amount paid by someone else, and who provided assistance. If the section is left blank
or lists all “$0’s” this form will be returned for completion and the process of your son/daughter’s financial aid
will be delayed.
1. Mortgage and property taxes or rent payment per month: Amount: $____ x 12 = yearly amount: $______
Who paid? Self/Spouse Bill in my/my spouse’s name but someone else gives money to pay
Allowed to live in someone else’s residence for free
Agency name:_________________________________________
Other:_______________________________________________
2. Utilities (electric, heat, etc.) per month: Amount: $_____ x 12 = yearly amount: $_________
Who paid? Self/Spouse Bill in my/my spouse’s name but someone else gives money to pay
Allowed to live in someone else’s residence
Agency name:_________________________________________
3. Food per month: Amount: $_____ x 12 = yearly amount: $_________
Who paid? Self/Spouse Bill in my/my spouse’s 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? Self/Spouse Bill in my/my spouse’s name but someone else gives money to pay
Allowed to use someone else’s vehicle
Agency name:_________________________________________
Other:_______________________________________________
5. Medical and dental costs per month: Amount: $_____ x 12 = yearly amount: $_________
Who paid? Self/Spouse Bill in my/my spouse’s 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? Self/Spouse Bill in my/my spouse’s name but someone else gives money to pay
Allowed to live in someone else’s residence for free
Agency name:_________________________________________
Turn over to complete
