Low Income Statement
Snead State Community College
2020-2021 Low Income Statement
Name: ________________________________________ Student Number: _______________________________
The income you reported on your FAFSA application appears to be unusually low. Please fill out the income
worksheet below. When completed, this worksheet should show how you were able to support yourself and/or
your family for 2018. If not complete, this form will be returned to you causing further delays in your verification
process.
Nontax filers must submit a copy of their wage and tax statement for each source of employment income for 2018
and this signed form identifying all income and taxes for 2018.
Please list total of all income received from January 1, 2018 – December 31, 2018 (not monthly):
Student Spouse/Parent(s)
Earnings from all jobs $____________ $____________
Unemployment compensation $____________ $____________
Withdrawals from savings accounts, retirement $____________ $____________
Sale of property, stocks, bonds, etc. $____________ $____________
Social Security benefits $____________ $____________
Welfare (TANF), AFDC $____________ $____________
Child support received $____________ $____________
Alimony received $____________ $____________
Cash received from family/friends (explain below) $____________ $____________
Benefits paid on your behalf (explain below) $____________ $____________
Other: (explain below) $____________ $____________
Benefits paid on your behalf: (Examples of support include bills, gasoline, clothing, transportation, etc.)
Be specific and list yearly amounts, not monthly.
________________________________________________________________________$____________
________________________________________________________________________$____________
________________________________________________________________________$____________
How were you able to meet your housing, food, clothing, transportation and other expenses?
I did not file a tax return for the 2018 tax year.
I certify, under the penalty of perjury, that the information provided is true and correct to the best of my
knowledge. I understand that the Financial Aid Office may request additional documentation to verify the
above information. Note: If you are married, both you and your spouse must sign below.
Signed: ___________________________________________________ Date:_________________________
Student
Signed: ___________________________________________________ Date:_________________________
Parent/Spouse
