Financial Support Worksheet
2015-2016
Student’s Name: _________________________________
SJC ID Number:______________
INSTRUCTIONS
We received a copy of your 2015-2016 Free Application for Federal Student Aid (FAFSA) and the income
reported appears to be unusually low. If you have no regular income, students (or parents) are required to
report any cash support they have received. Cash support includes money, gifts, loans, housing, food
clothing, and any other money someone provided on the student’s (or parents) behalf. For example, if a
friend or a relative pays all or part of the electric bill or rent you must report the amount.
You, or your parents, must complete sections 1-3 of this form. Return the completed form to the
financial aid office in 2 weeks. Incomplete forms will not be processed and “zero” resources in section
3 will not be accepted.
SECTION 1
1. The costs and resources listed are for the (circle one):
A. Student
How much of
this cost do
YOU pay each
month
How much of
this cost is paid
by someone else
each month
B. Parent(s)
Total money or
help you
received from
someone else
Cost Per
Month
How many
months do
you have
to pay this
Example: Rent
$450
12
$0
$450
=
$5,400
Example: Clothing
$40
9
$20
$20
=
$180
Student or Parent
Monthly Costs
=
Rent/Mortgage
$
$
=
$
Utilities (electric,
gas, water, heat)
Food and household
supplies
Automobile
payments
Transportation to
and from campus
Life and health
insurance
Medical expenses
not covered by
insurance
$
$
=
$
$
$
=
$
$
$
=
$
$
$
=
$
$
$
=
$
$
$
Child care/Day care
Clothing
$
$
=
$
$
$
=
$
Other
$
$
=
$
TOTALS
$
$
=
$
=
$
SECTION 2
If your income is unusually low because you were incarcerated please list dates of incarceration and
attach documentation to support your claim. Incarceration dates: _________________________
SECTION 3
MONTHLY RESOURCES
Where did you get your money to pay bills and expenses listed in Section 1? (Check all that apply.)
___ Income from work
___ Student Financial Aid
___ Child Support/Alimony
___ Savings
___ Aid from friends & relatives
___ Social Security
___ TANF/Food Stamps
___ Disability Payments
___ (Other) ______________
List the financial resources and the monthly dollar amounts that were used to meet your costs listed in Section
one. Be sure to include all resources such as those listed above and from jobs, pensions, unemployment,
credit card advances, personal loans, drawing account from business, etc.
Resources Used to Pay Expenses
Amount Received Per Month
EXAMPLE: Part-time landscaping
$250 per month
EXAMPLE: Boyfriend
$300 per month
1.
$
2.
$
3.
$
4.
$
5.
$
TOTAL MONTHLY RESOURCES
$
SIGNATURES
I (We) certify that the above information is correct and complete to the best of my (our) knowledge.
Signature: __________________________________ Date: ___________________
Ph: 505-566-3323 Fax: 505-566-3593 E-mail: [email protected]
Address: San Juan College, Financial Aid Office, 4601 College Blvd, Farmington, NM 87402