2020-2021 Revised 10/01/19
VERIFICATION OF ECONOMIC SUFFICIENCY 2020-2021
STUDENT NAME __________________________________ STUDENT ID _________________
Please complete the following information and return this form, along with any W-2 forms and Pay Statements, to:
Temple College
2600 South First Street
Temple, TX 76504-7435
ACTUAL 2018 INCOME INFORMATION:
STUDENT/SPOUSE ANNUAL
INCOME
ESTIMATED CURRENT YEAR INCOME INFORMATION:
STUDENT/SPOUSE ANNUAL
INCOME
If no source of income is given above, you must explain in the area below what income or other financial resources
are used to cover expenses such as housing, food, transportation, etc.
IMPORTANT: Do you or anyone in your household receive the following benefits?
Medicaid or Supplemental Security Income (SSI)? Yes ______ No ______
Supplemental Nutrition Assistance Program (SNAP)? Yes ______ No ______
Free or Reduced Price School Lunch? Yes ______ No ______
Temporary Assistance for Needy Families (TANF)? Yes ______ No ______
Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)? Yes ______ No ______
Student’s Signature: ________________________________________Date______________
Spouse’s Signature: _________________________________________ Date _____________
IF YOU ARE A DEPENDENT STUDENT, THEN YOUR PARENT MUST SIGN ALSO.
Parent’s Signature: _________________________________________Date _____________
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