Fillable Dependent Low Income Expense Form - 2015-2016 printable pdf download

DEPENDENT LOW INCOME EXPENSE FORM

2015 – 2016

Your application for financial aid was selected for review in a process called “Verification”. Based upon a review of your total

income/resources reported on your Verification Worksheet (V6), it was determined that your household income reported is unusually low

for the number of people reported in your household. This form must be completed by the parent who signed the 2015-2016 FAFSA

documenting all household expenses incurred during 2014.

A. Student Information

STUDENT NAME: _____________________________________________ GCU STUDENT NUMBER: _____________________________

Address: ___________________________________________________ Date of Birth: _______________________________________

City: __________________________ State: ___________ Zip: ___________ Phone No.:_______________________________________

B. Yearly Household Expenses for 2014

Parent: Please indicate your yearly household expenses for 2014 for each category below. Do not leave any answer in items 1-6 blank. If

the answer is “0” or not applicable, please place a “0” in the space provided and use the explanation section below to clearly explain why

the expense is “0” or not applicable. If you note an "Other Living Expense" in item 7, please note on the line provided a description of the

expense. An incomplete form will delay processing of your financial aid.

Total 2014 Annual

Type of Living Expense

Amount Paid

1. Housing/Rent/Mortgage

2. Groceries (food/beverage expense only)

3. Child Care

4. Transportation (e.g. vehicle payments, fuel, insurance, bus/taxi, maintenance)

5. Phone (land/cell/fax) and Utilities (electric/gas/water/trash)

6. Other Household Expenses

(e.g. hygiene, clothing, cleaning supplies, paper goods)

7. Other Living Expenses:

TOTAL YEARLY HOUSEHOLD EXPENSES FOR 2014:

0.00

Explanation for any items 1-6 above showing an amount of "0" or if the item is not applicable:

We will compare your total household resources reported on the Verification Worksheet (V6) to your expenses reported above. Your

child will be notified by the Student Services Advisor if additional information will be required.

C. Certification and Signature

(Handwritten Signature Required – Typed/Electronic Signature Not Accepted)

By signing below both student and parent whose information was reported on the FAFSA certify that all of the information reported is

complete and correct

Student Signature: ____________________________________________________

Date: ____________________________

Parent Signature: _____________________________________________________

Date: ____________________________

WARNING: Providing false or misleading information may be punishable by fines, jail, or both.

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Dependent Low Income Expense Form - 2015-2016