Micky mike

Tyler Junior College
Financial Aid Office

Low Income Worksheet
2011-2012

903-510-2385
903-510-2794 fax
faid@tjc.edu

Student Name:_________________________________ Student ID:A__________________
Federal guidelines require the Office of Financial Aid to verify the total income reported on the FAFSA,
but the income you and/or your family reported on your 2011-2012 FAFSA appearsinsufficient to
support you and/or your family. In the grid below, approximate the cost of living and the how these
costs were met. All lines must be completed even if a zero and payments must beexplained.
Dependent Students: This form must be completed by your PARENT!
Independent Students: This form must be completed by YOU (and your spouse).

Step 1: Expenses & Sources **DO NOT LEAVE BLANKS.**Did you (the student) receive Financial Aid in 2010?
Did a parent receive Financial Aid in 2010?
Yes

Yes
No

No

2010
Expense
Rent/House Payment
Electric Bill
Gas Bill
Water BillPhone/Cell Bill
Groceries
Child Care
Car Payment
Car Insurance
Medical/Dental
Personal
Credit Cards
Other

$ Per
Month

Source of Payment OR
Explanation of Zeros

Example: Job, SocialSecurity, CCMS, Paid
Off, No Gas, No Children, etc.)

$
$
$
$
$
$
$
$
$
$
$
$
$

2011
$ Per
Month

Source of Payment OR
Explanation of Zeros

Example: Job, Social Security, CCMS,Paid Off, No Gas, No Children, etc.)

$
$
$
$
$
$
$
$
$
$
$
$
$

Step 2: Please list and explain any changes to the above information for 2011:____________________________________________________________________________ __
_____________________________________________________ _________________________
Are you working now?
Yes
No
Estimated Monthly Income: _________________Are you working for a new employer?
Yes
No
If yes, please list: Current ____________________________ Previous ___________________________

Step 3: Certifications
I/We certify that the...