2012-2013 CURRENT HOUSEHOLD SIZE/NUMBER IN POST-SECONDARY SCHOOLS STATEMENT

Student Name Student ID #

LIST ALL FAMILY MEMBERS THAT RECEIVE MORE THAN ½ OF THEIR SUPPORT FROM YOU (OR FROM YOUR PARENTS IF DEPENDENT STUDENT). INCLUDE YOURSELF AND PARENTS. IF A FAMILY MEMBER WILL ATTEND COLLEGE HALF-TIME OR MORE IN 2012-2013, PRINT THE NAME OF THE COLLEGE

Family Member 1 Name Age Relationship to Student College

Family Member 2 Name Age Relationship to Student College

Family Member 3 Name Age Relationship to Student College

Family Member 4 Name Age Relationship to Student College

Family Member 5 Name Age Relationship to Student College

Family Member 6 Name Age Relationship to Student College

Family Member 7 Name Age Relationship to Student College

IF NUMBER OF NAMES LISTED IS DIFFERENT FROM NUMBER OF EXEMPTIONS ON THE 2011 TAX RETURN (MINUS ANY EXEMPTION FOR AGE OR BLINDNESS), EXPLAIN THE DIFFERENCE BELOW:

I certify that the information on this form is true and correct by signing with either an original or electronic signature.

Student's Signature: ________________________________________ Date:

Parent's Signature: ________________________________________ Date:

Complete, print, and return completed form to:

Office of Financial Aid
Box 93260 MSU
Lake Charles, LA 70609
Phone: (337) 475-5065
Fax: (337) 475-5068
E-mail: finaiddocs@mcneese.edu