Office of Student Financial Aid
Non-Parental Support Form 2020-2021
Student Name: ___ _ Banner: XXX________ _____
Last 6 Digits Only
Federal guidelines require that the Office of Student Financial Aid confirm the natural parent(s) of the above student
is not providing any support for the student in the current academic year and the parent(s) has refused to submit
their information on the student’s Federal Application for Federal Student Aid (FAFSA).
I/We, _______ and _______________
Print Parent(s) Name Print Parent(s) Name
Attest that I/We are not providing any support to the student for the academic year 2020 – 2021.
I/We will not provide any financial support for housing, food or clothing.
I/We did not claim the student as a dependent on our taxes for 2018 and will not claim the student as a
dependent for tax year 2019.
I/We will not provide any medical/dental insurance coverage.
I/We will not provide any automobile insurance or provide financial support for an automobile.
I/We will not pay for any educational expenses for the student including but not limited to tuition, fees, room,
board, books, transportation, or miscellaneous expenses.
I/We will not apply for a Parent Plus Loan for the student for this academic year
I/We refuse to complete and submit any information on the Federal Application for Federal Student Aid
Please indicate the date in which all parental support ended ____
/ / .
If this request is approved, the student will only be eligible for Federal Direct Unsubsidized Loan for the
academic year based on the student’s classification.
Certification Read carefully before you sign.
I hereby certify that all information contain in this document is true and complete. I affirm that I have not knowingly provided
any false statements or fraudulent documentation. I understand that if I am found to have knowingly or intentionally given
false or fraudulent statements and/or documentation, my eligibility for Federal and State student aid may be canceled.
Note: Federal regulations stipulate that evidence of fraud must be reported to the U.S. Department of Education for possible
investigation by the Office of the Inspector General and possible prosecution by the United States Attorney General’s Office.
Form must be notarized if parent is not completing the form in the Office of Student Financial Aid.
/ /
Parent’s Signature Date
____________________________________________ / /
Parent’s Signature Date
/ /
Student’s Signature Date
Please mail document to:
North Carolina Agricultural and Technical State University
Office of Student Financial Aid
1601 E. Market St.
Greensboro, NC 27411
(336) 334-7973 Fax# (336) 334-7954