Please read, sign and date.
If you are the parent or the student, by signing this form you agree, if asked, to provide information that will verify
the accuracy of this completed form. This information may include your U.S. or state income tax forms, divorce
decree, utility bills, etc. Also, you certify that you understand that the Secretary of Education has the authority
to verify information reported on this form with the Internal Revenue Service and other federal agencies.
If you purposely give false or misleading information, you may be fined $20,000, sent to prison, or both.
Student's Signature: ____________________________________________ Date: _____________________________
Parent's Signature: ____________________________________________ Date: _____________________________
FAA Comments :
University ID (or Social Security Number)
Full Name Age
Enrolled at Least Half-
Time (Yes or No)
Southeastern LA Univ.
Dependent Student's Family Information
List below the people in your parent(s) household. Include:
• Yourself and your parent(s) (including a stepparent) even if you don't live with your parent(s).
• Your parent(s) other children if your parent(s) will provide more than half of their support from July 1, 2019,
through June 30, 2020, or if the other children would be required to provide parental information if they were
completing a FAFSA for 2019-20. Include children who meet either of these standards, even if they do not live
with your parent(s).
• Other people if they now live with your parent(s) and your parent(s) provide more than half of their support and
will continue to provide more than half of their support through June 30, 2020.
For any household member, excluding the parent(s), who will be enrolled at least half-time in a degree, diploma, or
certificate program at an eligible postsecondary educational institution any time between July 1, 2019 and June 30,
2020, include the name of the college.
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