2015-2016 | Office of Student Financial Assistance HOUSEHOLD SIZE FORM DEPENDENT Student’s Name:_______________________________ UCFID:____________________________ Address:_____________________________________ Date: _____________________________ City:_________________________________________ State/Zip:__________________________ Parent’s Name(s):______________________________ Phone:____________________________ Complete items A through D carefully. Be sure to provide complete information for each household member and enter N/A for items that do not apply. Leaving items blank on any household member can result in processing delays. A. You and Your Parent(s)/Step-Parent(s) Full Name Date of Birth Relationship Student / Self Parent 1 (father, mother, stepparent) Parent 2 (father, mother, stepparent) B. Your Siblings: List siblings who will receive more than half of their financial support from your parent(s) between July 1, 2015 and June 30, 2016, or are required to use parent information when completing the FAFSA. Full Name John Example Date of Birth mm-dd-yyyy Relationship Claimed on Parent’s 2014 taxes? 01/25/1993 brother yes If attending college, list: College Name, City, State UCF Orlando, FL Type of Degree Seeking BA # of credits taking FALL 15 12 SPR 16 12 SUM 16 0 1. 2. 3. C. Other Dependents: List other dependents who live with your parent(s) AND will receive more than half of their financial support from your parent(s) between July 1, 2015 and June 30, 2016. Full Name Jane Example Date of Birth mm-dd-yyyy Relationship Claimed on Parent’s 2014 taxes? 01/25/1993 niece yes If attending college, list: College Name, City, State n/a Type of Degree Seeking n/a # of credits taking FALL 15 n/a SPR 16 n/a SUM 16 n/a 1. 2. 3. D. Federal Means Tested Benefit Programs: Did any member of your parent’s household size receive any of the following federal benefits in 2013 or 2014? Supplemental Security Income (SSI from SSA Form 2458)? Yes No WIC? Yes No Free or Reduced Lunch? Yes No Food Stamps (SNAP)? Yes No Temporary Assistance for Needy Families (TANF)? Yes No _____________________________ __________________________ Student’s Signature Date _____________________________ __________________________ Parent’s Signature Date Office of Student Financial Assistance Millican Hall, Room 120  Orlando, FL 32816-0113  Phone: (407) 823-2827  Fax:(407) 823-5241 www.finaid.ucf.edu An Equal Opportunity and Affirmative Action Institution Dep_hhs1516-Rev02/15