2324 Household Size Verification - Dependent (MISC4/EXPLN; Note)

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2023-2024 Household Size Verification for Dependent Students

Student ID number*

Please be sure to enter your full, correct student ID number. Without a correct student ID number will will not be able to associate this form with your financial aid file.

Name*

First Name

Last Name

Phone Number

Household Member Verification

You have included an individual in the family information section of your 2023-2024 Verification of Family Information for Dependent Student form that is not you, your parent(s), and/or siblings. We need additional information to verify the amount of financial support your parent(s) provide to this individual. Please provide the following information below:

Household Member Information

Name of household member who is not you, your parent(s), or sibling(s) as it appears on your 2023-2024 Verification Worksheet:*

First Name

Last Name

Age of household member listed above:*

What is this household member's relationship to you?*

How much do your parents contribute financially each month towards the support of the above referenced household member?* $

What is this household member's average monthly income?* $

What is the date range that this household member will be residing in the household?

Do you have more household members listed on your verification worksheet to list who are not you, your parent(s), and/or siblings?*

Yes No

Household Member Information 2

Name of household member who is not you, your parent(s), or sibling(s) as it appears on your 2023-2024 Verification Worksheet:*

First Name

Last Name

Age of household member listed above:*

What is this household member's relationship to you?*

How much do your parents contribute financially each month towards the support of the above referenced household member?* $

What is this household member's average monthly income?* $

What is the date range that this household member will be residing in the household?*

Do you have more household members listed on your verification worksheet to list who are not you, your parent(s), and/or siblings? 2*

Yes No

Household Member Information 3

Name of household member who is not you, your parent(s), or sibling(s) as it appears on your 2023-2024 Verification Worksheet:*

First Name

Last Name

Age of household member listed above:*

What is this household member's relationship to you?*

How much do your parents contribute financially each month towards the support of the above referenced household member?* $

What is this household member's average monthly income?* $

What is the date range that this household member will be residing in the household?*

Do you have more household members listed on your verification worksheet to list who are not you, your parent(s), and/or siblings? 3*

Yes No

Household Member Information 4

Name of household member who is not you, your parent(s), or sibling(s) as it appears on your 2023-2024 Verification Worksheet:*

First Name

Last Name

Age of household member listed above:*

What is this household member's relationship to you?*

How much do your parents contribute financially each month towards the support of the above referenced household member?* $

What is this household member's average monthly income?* $

What is the date range that this household member will be residing in the household?*

Do you have more household members listed on your verification worksheet to list who are not you, your parent(s), and/or siblings? 4*

Yes No

Household Member Information 5

Name of household member who is not you, your parent(s), or sibling(s) as it appears on your 2023-2024 Verification Worksheet:*

First Name

Last Name

Age of household member listed above:*

What is this household member's relationship to you?*

How much do your parents contribute financially each month towards the support of the above referenced household member?* $

What is this household member's average monthly income?* $

What is the date range that this household member will be residing in the household?*

Do you have more household members listed on your verification worksheet to list who are not you, your parent(s), and/or siblings? 5*

Yes No

Household Member Information 6

Name of household member who is not you, your parent(s), or sibling(s) as it appears on your 2023-2024 Verification Worksheet:*

First Name

Last Name

Age of household member listed above:*

What is this household member's relationship to you?*

How much do your parents contribute financially each month towards the support of the above referenced household member?* $

What is this household member's average monthly income?* $

What is the date range that this household member will be residing in the household?*

Do you have more household members listed on your verification worksheet to list who are not you, your parent(s), and/or siblings? 6*

Yes No

Please upload a list of the household members listed on your verification worksheet to list who are not you, your parent(s), and/or siblings who you have not already listed.

Include these items:

Name
Age
Relationship to you
Amount that your parents contribute to each member financially each month
Average Monthly income for each member
Date range that each member will be residing in the household

Upload List*

No File Chosen

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Include any additional explanations or comments below:

Sign and Submit

Student: By clicking the box below you certify that you are the above named student and that you agree to submit this document electronically.*

I certify that I am the above named student and choose to submit this form electronically.

Student: By clicking the box below you certify that you are the above named student and that you agree to submit this document electronically. - Copy*

By signing this document, I certify that the information is complete, true and accurate. I understand that purposely providing false or misleading information could result in criminal prosecution, prison sentence, and/or a fine pursuant to U.S. Criminal Code and Colorado Criminal Code.

Student Email Address*

Due to privacy regulations this form will not be valid without your student email address. Do not use a personal or work email.

Parent: By clicking the box below you certify that you are the parent of the above named student and that you agree to submit this document electronically.*

I certify that I am the parent of the above named student and choose to submit this form electronically.

Parent Name*

First Name

Last Name

Parent Email*

IMPORTANT: Financial Aid can only pay for the classes required by your declared major. Please refer to your degree check or make an appointment with your advisor.

The Community College of Aurora prohibits all forms of discrimination and harassment including those that violate federal and state law, or the State Board for Community Colleges and Occupational Education Board Policies 3-120 and 4-120. The College does not discriminate on the basis of sex/gender, race, color, age, creed, national or ethnic origin, physical or mental disability, veteran status, pregnancy status, religion, genetic information, gender identity, or sexual orientation in its employment practices or educational programs and activities. The Community College of Aurora will take appropriate steps to ensure that the lack of English language skills will not be a barrier to admission and participation in vocational education programs.

Community College of Aurora Financial Aid Office 16000 E. CentreTech Parkway, Suite A103 Aurora, CO 80011

Phone: 303-360-4709 Fax: 303-361-7401 Email: FinancialAid@CCAurora.edu