Fillable Form 20202021: Childcare Budget Adjustment Request Form (Haskell Indian Nations University)

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Form 20202021: Childcare Budget Adjustment Request Form (Haskell Indian Nations University)

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The Form 20202021: Childcare Budget Adjustment Request Form (Haskell Indian Nations University) form is 2 pages long and contains:

  • 4 signatures
  • 13 check-boxes
  • 70 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Haskell Indian Nations University

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Haskell Indian Nations University
Financial Aid Office
155 Indian Avenue, Box 5027
Lawrence, KS 66046
Phone:
785‐749‐8468
Fax:
785‐832‐6617
Email: Faoffice@haskell.edu
1 | P a g e 2 0 20 ‐ 2 0 2 1 C h i l d c a r e B u d g e t A d j u s t m e n t F o r m
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2020‐2021
Childcare Budget Adjustment Request Form
Students must be the custodial parent of the child(ren) in daycare and be enrolled at least half‐time. Students must submit the 2020‐
2021 Free Application for Federal Student Aid (FAFSA) at www.FAFSA.ED.GOV
and have a complete financial aid file.
You may submit a request anytime during the academic year. Please complete the form in its entirety. Childcare costs will be added
to your estimated cost of attendance.
I.
Student Information (incomplete or inaccurate information may delay the process of this request):
Student’s Name: Student ID:
Address:
City: State: _ Zip:
Phone Number:
Email address:
Hours of Enrollment: Fall 2020: Spring 2021:
Note: if you exclude your expected Spring 2021 enrollment, you will only be considered for a Fall 2020 adjustment.
Employment Status: Unemployed
How many hours do you work per week?
Marital Status: Married:
Academic Status: Full‐time
Employed
Unmarried, separated, divorced, widowed)
Part-time
Student’s Signature Date
II.
Spouse Information (required, if applicable):
Spouse’s Name:
Spouse’s Employment Status: Unemployed
How many hours do you work per week?
Employed
Is your spouse enrolled in college? Yes_ No_ If yes, where?
If yes, list numbers of hours: Fall 2020 Spring 2021
Note: if you exclude your expected Spring 2021 enrollment you will only be considered for a Fall 2020 adjustment.
Spouse’s Signature (required, if applicable) Date
III.
Son/Daughter Information:
Name(s) Birth date(s) Age(s)
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Haskell Indian Nations University
Financial Aid Office
155 Indian Avenue, Box 5027
Lawrence, KS 66046
Phone:
785‐749‐8468
Fax:
785‐832‐6617
Email: Faoffice@haskell.edu
2 | P a g e 2 0 20 ‐ 2 0 2 1 C h i l d c a r e B u d g e t A d j u s t m e n t F o r m
____
_____
____
How often does your child (or children) live with you? 7 days/week _ 3‐6 days/week Fewer than 3 days/week _ _
Specify the grade your children are enrolled in:
IV.
Childcare Provider Information (if you have more than two providers, please attach an additional copy of
this page)
This Information must be completed by the Childcare Provider(s)
The information provided must be accurate and FAO staff may verify this information.
Childcare Provider #1 Childcare Provider #2
Name(s) of Children
Date
Hours in
care/week
Cost Per
Month
Name(s)
Date
Hours in
care/week
Cost Per
Month
Signature Date Signature
Date
Childcare Provider’s Name
Childcare Provider’s Name
Childcare Provider’s City, State
Childcare Provider’s City, State
Childcare Provider’s Phone Number
Childcare Provider’s Phone Number
FOR OFFICE USE ONLY
Child Care Adjustment: Semester__________ Denied__________ Approved ____________
Financial Aid Officer Signature _____________________________________ Date_______________
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Form 20202021: Childcare Budget Adjustment Request Form (Haskell Indian Nations University)

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Completed 1 February 2021

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