North Central State College
Financial Aid Office
Low income worksheet – student
2016-2017
Name (print) _______________________________________________ NCSC I.D. _______________________
Because you reported on your FAFSA that you had little or no income in 2015, we need information which shows
how you supported yourself (and if you have children, how you supported them as well) last year. Please answer
the following questions, and when completed, submit this worksheet to the Financial Aid Office
Answer all questions.
□ Yes
1. Did you file a federal tax return for 2015?
□ No
2. Did you work and earn wages in 2015?
□ Yes
3. Where do you live?
□ Away from parents?
□ With parents
4. If away from parents, do you:
□ No
□ Own your own house
□ Rent
5. If you rent, how much is the monthly rental charge? $__________ Of this, how much do you pay?
$__________ If you do not pay the entire rent, who pays the rest? ______________________________
How do you obtain the funds to make your rental payment? ____________________________________
_____________________________________________________________________________________
6. If you live in your own home, what is your monthly mortgage payment? $____________ How much do
you pay in property taxes every six months? $____________ How do you obtain the funds to pay your
mortgage and property taxes? ________________________________________________________
7. How much, on average, are your utility charges each month? Electric $__________ Gas $__________
Water/sewer $_________
TV $__________
Phone $__________
Internet $__________
How do you obtain the funds to pay for your utilities? ________________________________________
8. How much, on average, do you spend each month for food? $___________ How do you obtain the
funds to pay for food? __________________________________________________________________
9. Do you have children?
□ Yes
□ No
10. Does anyone claim your children on their taxes?
Over
Who? ____________________________________
11. Do your children have medical insurance?
□ Yes
□ No
If yes, who pays for the insurance?
____________________________________________________________________________________
12. How much do you receive each month from the following non-taxed benefit programs?
Cash welfare $__________ Food Stamps $__________ Unemployment compensation $___________
Child support $__________ Social Security for any member of the family including SSI $___________
Workers’ Compensation $__________ A friend or family member who gives you money or pays your
bills $__________
Other $__________
13. Has your personal and/or financial situation changed in 2016 from what it was in 2015? □ Yes
□ No
If yes, explain:_________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
14. In addition to completing this form, you are required to contact the United States Internal Revenue Service
(the federal income tax office) and obtain documentation. Submit the documentation with this form.
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•
If you (and/or your spouse if married) DID file federal taxes for 2015, ask the IRS for a Tax
Return Transcript for 2015.
If you (and/or your spouse if married) DID NOT file federal taxes for 2014, ask the IRS for a
Non-Filer Statement for 2015. Note that Non-Filer Statements are usually not available until
after June 15.
The IRS can be contacted by:
• Going on line to www.irs.gov – or
• Calling by phone to 1-800-908-9946 – or
• Going to the Mansfield IRS office at 180 N. Diamond St. (next to the main post office).
Certification - All information presented on this form is true and complete to the best of my knowledge.
Student signature __________________________________________ Date _______________________
143 Kee Hall
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2441 Kenwood Circle
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[email protected]
Mansfield, Ohio 44906
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419-755-4899 (voice)
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419-755-4729 (fax)
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http://www.ncstatecollege.edu/cms/financial-aid.html