Parent Low Income Verification Form
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1Parent Low Income Verification Form (for dependent students)
Student:
RAM ID#:
The information you provided on the FAFSA for your parent(s) reflects a particularly low income;
therefore we must ask you to verify how your entire family met living expenses in 2012.
Mortgage or rent payment per month:
Amount: $
1.
Who paid?
parent(s)
bill in parent name-someone else gives money to pay
allowed to live in someone else’s residence for free
2. Utilities (electric, heat, etc.) per month:
Amount: $
Who paid?
parent(s)
bill in parent name-someone else gives money to pay
allowed to live in someone else’s residence for free
3.
Food per month:
Amount: $
Who paid?
parent(s)
bill in parent name-someone else gives money to pay
allowed to live in someone else’s residence and eat their food
4.
Transportation (car insurance, gas, train, bus, etc.) per month:
Amount: $
Who paid?
parent(s)
parent name-someone else gives money to pay
allowed to use someone else’s vehicle
5. Medical and dental costs per month:
Amount: $
Who paid?
parent(s)
bill in parent name-someone else gives money to pay
given free services from
6.
Clothing, personal expenses, and spending money per month:
Amount: $
Who paid?
parent(s)
bill in parent name-someone else gives money to pay
Signature/Student:
Date:
Signature/Parent:
Date:
Name and relationship of any other person(s) who paid/assisted with any of the above expenses:
Name
_______________ ________ Relationship
_________________ _
Name
___
__________________________ Relationship______________________________
Signature of any other person(s) who paid/assisted with any of the above expenses:
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