Fillable STUDENT NAME BRANDMAN ID NUMBER (Brandman University)

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STUDENT NAME BRANDMAN ID NUMBER (Brandman University)

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File type: PDF

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2019-2020 SUPPORT STATEMENT FORM
Page 1 of 2
STUDENT NAME BRANDMAN ID NUMBER
Additional information is needed about people in your household for whom you (or your parent, if dependent)
will provide more than 50%
of their support.
I have included documentation of the permanent address for the person(s) listed below:
Yes No If No, explain: _______________________________________________
Resources of the persons you (or your parent, if dependent) support for 2019:
(list annual amount, do not leave any items blank, if it does not apply use zero or n/a)
Name/Relationship:
Name/Relationship:
Name/Relationship:
Name/Relationship:
Resource:
Annual Amount
Annual Amount
Annual Amount
Annual Amount
Income from work
$
$
$
$
Unemployment,
Welfare/TANF, SNAP, WIC,
etc. Include amounts received
on their behalf.
$
$
$
$
Financial aid refunds
$
$
$
$
Social Security Income
(Retirement or Disability),
pensions, VA Benefits
$
$
$
$
Alimony, child support
$
$
$
$
Other income
(specify here):
$
$
$
$
Cash support from family
members (other than you or
your parent, if dependent)
$
$
$
$
Current amount in their
savings and checking
accounts
$
$
$
$
2019-2020 SUPPORT STATEMENT FORM
Page 2 of 2
Expenses of the person(s) supported for 2019: (annual amount)
Name:
Name:
Name:
Annual Amount
Annual Amount
Annual Amount
Clothing
$
$
$
Medical, dental
$
$
$
Transportation
$
$
$
Other (specify):
$
$
$
Expenses for the entire household for 2019 (annual amount):
Housing for entire year (Complete either item a or b)
(a) Rent paid
$
(b) Or, mortgage payment
$
Food
$
Utilities (internet, electricity, heat, light, water, etc. that are not already included in line a or b)
$
Mobile Phone
$
Repairs/Maintenance (not included in line a or b)
$
Other Expenses (specify):
$
Total number of persons who live in the household
STUDENT SIGNATURE DATE
PARENT SIGNATURE IF DEPENDENT DATE
CERTIFICATION: All of the information on this form is true and complete to the best of my knowledge. If asked by the financial aid
office, I agree to give proof of the information provided on this form. I understand that giving incomplete, misleading or false
information may result in significant processing delays, reduced eligibility and/or repayment of aid.
Submit Completed Form via the Student Portal
OR Fax: 866-659-1147 Mail: Brandman University, Financial Aid Office, Third Floor 16355 Laguna Canyon Rd, Irvine, CA 92618
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STUDENT NAME BRANDMAN ID NUMBER (Brandman University)

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Completed 21 July 2020

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