Submit this completed form and all supporting documents to Lamar State College Port Arthur Financial Aid Office using your preferred method.
Mail: LSCPA Office of Financial Aid ▪ PO Box 310 ▪ Port Arthur, TX 77641 Drop off: 304 Student Center
Scan and email: FinancialAid@lamarpa.edu Fax: 409-984-6021
Revised 10/21/2019
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9. Are you or your dependent receiving support from anyone else, other than your parents, for your dependent’s care?
(Includes cash, bills paid for you, supplies like food and diapers, and indirect support such as housing & insurance).
No
Yes ‐ Provider’s Relationship to Dependent: __________________________________________________
TY
PES: _____________________________________________________________________________
T
otal estimated value per month: __________________
IF YOUR DEPENDENT IS NOT YOUR BIOLOGICAL CHILD
10. Are you receiving support from someone else for your dependent’s care? (Includes cash, bills paid for you, supplies
like food and diapers, and indirect support such as housing & insurance). Please Provide Documentation.
No
Yes – Provider’s Relationship to Dependent: _________________________________________________
T
YPES: _____________________________________________________________________________
T
otal estimated value per month: __________________
11. I
s your dependent receiving support from someone else for their care? (Includes cash, bills paid for you, supplies like
food and diapers, and indirect support such as housing & insurance). Please Provide Documentation.
No
Yes – Provider’s Relationship to Dependent: _________________________________________________
T
YPES: _____________________________________________________________________________
T
otal estimated value per month: __________________
12. I
s your dependent receiving other benefits (WIC, Medicaid, Disability, Social Security, etc.), paid to them directly?
Please Provide Documentation.
No
Yes – TYPES: _________________________________________________________________________
Total estimated value per month: ___________________
Signature
I certify that all of the information reported on this worksheet is complete and correct.
WARNING: If you purposely give false or misleading information on this worksheet, you may be fined, be sentenced to jail, or both.
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__________________________________________________ __________________________________________________
Student’s Signature Date Parent’s Signature (if applicable) Date
