(10‐14‐19)
Student Low Income Form
Expense/Resource Worksheet 2020-2021
Did you receive any other income and/or in-kind support? I understand that if I do not report any income or in-
kind support on this form, the Financial Aid Office will be unable to process financial aid.
$ __________ Income from work – Must provide copies of all 2018 W2’s.
$ __________ Financial Aid Awards in 2018
$ __________ Child Support received in 2018
$ __________ Social Security Benefits received in 2018 and/or 2019, including Disability
$ __________ Pension or Retirement Payments in 2018
$ __________ Veterans Non-education benefits in 2018
$ __________ Welfare and/or DHHR Benefits in 2018 or 2019
$ __________ TANF benefits in 2018 or 2019
$ __________ SNAP benefits in 2018 or 2019
$ __________ Subsidized housing in 2018 or 2019
Money received or paid on student(s) behalf (e.g., bills), not reported elsewhere on this form.
This includes money that you received from a parent or other person whose financial information is not reported on this
form and that is not part of a legal child support agreement.
$ __________ Other Income in 2018 Source: _________________________
$ __________ Non-spouse Contributing Member in 2018 Relationship: _____________________
Certifications and Signature
The person signing below certifies that all of the
information reported is complete and correct.
Print Student’s Name: __________________________ Student’s ID# __________________
Student’s Signature: __________________________ Date: ________________
WARNING: If you purposely give false or
misleading information, you may be fined,
sent to prison, or both.
click to sign
signature
click to edit
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