DEPENDENCY DETERMINATION FORM 2016-2017

DEPDTR page 1
Ferris State University Office of Scholarships & Financial Aid
DEPENDENCY DETERMINATION FORM
2016-2017
This Space For Office Use Only – Please leave blank
FIRST NAME
MIDDLE
LAST
___________________________________________
Student ID #
____________________________________________
Phone Number (include area code)
___________________________________________
Permanent Address (include Apt. Number)
____________________________________________
City
State
Zip Code
You indicated on the FAFSA that you (student) are supporting a child(ren) or other legal
dependent(s). This form is required to clarify your dependency status.
1) Do you (student), or will you, between July 1, 2016 and June 30, 2017, provide more than 50% of the
support of a child or other legal dependent? YES ______ NO ______
If “NO”, please log back into your FAFSA, click on “Make corrections to a processed FAFSA” then change the
answer to the question on the FAFSA which asks “Do you have children who will receive more than half of
their support from you between July 1, 2016 and June 30, 2017” to “NO”. You will then be prompted to
answer questions regarding your parent(s) and also provide parental tax information. Don’t forget to submit
the FAFSA corrections and include your parent’s signature. Once you have corrected your FAFSA, please skip
the remaining questions below, sign and date this form and submit it to the Financial Aid Office.
If “YES”, please complete all of the remaining questions on this form, sign and submit.
2) What is the living arrangement for you and your child(ren)/legal dependent? (Please check the appropriate
response)
A. My child(ren)/legal dependent and I live in my parent(s)’ home. _______
B. My child(ren)/legal dependent and I live in an apartment or home that I own, lease or rent. _______
(YOU MUST SUBMIT A COPY OF YOUR APARTMENT OR HOME RENTAL AGREEMENT, LEASE, DEED,
MORTGAGE CONTRACT, ETC. WITH THIS FORM)
C. My child(ren)/legal dependent do(es) not live in my residence. _______
D. My child(ren)/legal dependent and I live with someone other than my parents. ______
If you checked D, please indicate with whom you and your children live
_________________________ and the relationship between you and this person or persons:
_________________________________________________________________________________.
P:Forms/1617/DEPDTR.docx
DEPDTR page 2
Ferris State University Office of Scholarships & Financial Aid
DEPENDENCY DETERMINATION FORM (Ctd)
2016-2017
This Space For Office Use Only – Please leave blank
3)
Please list the name(s) and ages of the children/legal dependent that you will support between July 1,
2016 and June 30, 2017. If your child is not yet born, please list “Unborn” in the Child Name column
below and provide a statement from your doctor’s office including the expected delivery date of your
child.
CHILD/LEGAL DEPENDENT NAME
AGE
DATE OF BIRTH
___________________________
______
_________________________________
___________________________
______
_________________________________
___________________________
______
_________________________________
___________________________
______
_________________________________
4) Please list all of your current financial resources that you use to support your child(ren). Include
amounts and source of income, such as earned wages, food stamps, FIA benefits, child support
received, funds provided by parents or other persons such as boyfriends, etc. Do not include financial
aid. YOU MUST SUBMIT DOCUMENTATION OF ANY RESOURCES YOU REPORT BELOW (COPIES OF PAYSTUBS,
FIA BENEFIT AWARD STATEMENTS, CHILD SUPPORT COURT ORDERS, ETC.)
SOURCE OF INCOME
AMOUNT RECEIVED
DATES RECEIVED
(EXAMPLE – “Wages”)
(EXAMPLE - $1000 PER MONTH)
(Include Current Income, if any)
________________________
$__________________________
________________________________
________________________
$__________________________
________________________________
________________________
$__________________________
________________________________
________________________
$__________________________
________________________________
________________________
$__________________________
________________________________
Please submit this form and any documentation requested above to the FSU Financial Aid Office. A
determination of dependency will typically be made within 7 days of the receipt of this form. Failure
to provide requested documentation may result in a delay of financial aid processing. Questions may
be addressed by emailing [email protected] or by calling 231 591-2110.
____________________________________________________________
STUDENT SIGNATURE
Timme Center for Student Services
1201 S. State Street, CSS 101
Big Rapids, MI 49307 FAX 231-591-2950
EMAIL [email protected]
__________________________
DATE
Kendall College of Art and Design of FSU
17 Fountain Street NW
Grand Rapids, MI 49503 FAX 616-831-9689