Financial Aid Office
(708) 709-3735
Fax: (708) 709-3716
M:\StuServ\FAVAoffice\2015-16 Forms\LowincomedocumentStudentforfillable.docx
2015-16 Independent Low Income Document
To be completed by Student
Student’s Name ID#/SS#
The Office of Financial Aid is in the process of reviewing your for financial aid and has found that additional
information is required in order to determine his/her eligibility. On the Free Application for Federal Student Aid
(FAFSA) you reported one of the following
No income reported in 2014;
Some or all of the income section on the FAFSA was left blank; or
You reported unusually low income that appears to be inconsistent with the number of family
members supported.
Using the chart below, list the 2014 yearly living expenses for your household. You will need to indicate
your yearly amount due, how much was paid, any amount paid by someone else, and who provided
assistance. If the chart is left blank or lists all “$0’s” this form will be returned for completion and the
process of your financial aid will be delayed. Please carefully review the examples below to see how to
properly report your information.
2013 Household Living Expenses
Who provided the
assistance?
(i.e. social services, HUD,
friend, relative, significant
other, parents, etc.)
Housing (rent or mortgage)
(heat, electricity, phone, etc.)
(health, life, car, renter’s, home, etc.)
Medical/dental (Medicaid, enter $0)
(bus, car, gas, subway, etc.)
Clothing/Other personal expenses
Student Resources: Did you receive free housing, utilities, transportation, or other living expenses from
a friend, relative, or someone with whom you have a relationship? Yes No
If yes, provide the name and relationship of any other person(s) who paid/assisted with any of the
above expenses:
Name______________________________________Relationship________________________________
Name______________________________________Relationship________________________________
Turn over to complete