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Income Certification 2023 – 2024

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Student Name*












Upon reviewing the results of your Free Application for Federal Student Aid (FAFSA), we note that your income is unusually low. Please complete the following information so that we may determine how you supported yourself and/or your dependents.

Do you and your dependents live with your (or your spouse’s) parents?*


Do you and your dependents live with someone other than a parent who provides for your basic necessities (food, shelter, clothing, etc.)?*


Do you (or your spouse) currently receive any of the following:







Are you or your spouse currently employed?*


Does someone pay bills in your (your spouse’s) name on your behalf?*


My signature certifies that the information provided is true and correct and that I am providing an accurate description of my financial situation. I understand that purposely giving false or misleading information could result in a fine, imprisonment or both as it relates to my reporting information to the U.S. Department of Education.

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