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Student Low Income Form 2013-2014

Student Low Income Form 2013-2014

Student Low Income 2013-2014

Your (and your spouse's) reported income for 2012 was unusually low. Please indicate how your household expenses were paid from January 1, 2012 to December 31, 2012. Please enter amounts for all items. If the item does not apply indicate "zero".
In 2012 I lived (check one)

Expenses for 2012

Housing

Rent/Mortgage
$
$

Utilities

Electricity/Gas
$
$
Water/Sewer
$
$
Transportation
Car Note
$
$
Insurance
Fuel
$
$
Personal
Food
$
$
Medical
$
$
Daycare
$
$
TOTAL EXPENSES
$
Income for 2012
Earned income from W-2s, business or farm
$
$
Unemployment Compensation
$
$
TANF, AFDC, etc.
$
$
Food Stamps
$
$
Housing Assistance
$
$
Disability Income
$
$
Workman's Compensation
$
$
Financial Aid/Scholarships
$
$
Child Support
$
$
Other
$
$
TOTAL INCOME
$
If the total amount of expenses is greater than your total income please explain how this expense was provided for.
I certify that the inforamtion on this form is true and correct by signing with either an original or electronic signature.

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