2023-2024 Verification of Support of Dependents

2023-2024 Verification of Support of Dependents
If you need assistance with this form, contact Mid Michigan College Financial Aid at Phone (989) 386-6664 or finaid@midmich.edu.
Student Name *

First NameLast Name
Mid Michigan College Student ID Number*
You can find your Student ID Number on your Mid Michigan College Student ID Card or in myMid.
Phone Number*

Area CodePhone Number
Student Email Verification

To complete and submit this form, you must verify your Mid Mich Email.
Enter Your Mid Mich Email*
You MUST provide a Mid Mich Email so that we can verify your identity. Other emails will not be accepted and you will be unable to complete this form.
ERROR The email you entered is not a Mid Mich Email. In order to complete this form, you must enter a Mid Mich Email so we can verify your identity.
Re-enter your Mid Mich Email for verification, Click 'Verify Email', and follow the directions. *
Student Status
Are you completing this form as a dependent or independent student? You would have filed your FAFSA in the same manner. Note: If you are required to provide parent information and signatures on your FAFSA, you are a dependent student and will need to provide information for yourself and your parents on this worksheet.*

DependentIndependent
Parent Email
You MUST provide a valid Parent Email that is different from the Student Mid Mich Email so that we may verify your parent's identity.
ERROR The email you entered is the same as the Student's Mid Mich Email. In order to complete this form, you must enter a valid email that is different from the Student's Mid Mich Email so we can verify your parent's identity.
Re-enter your Parent Email for verification, Click 'Verify Email', and follow the directions. *

You have indicated that you have a child or dependent(s), or that your parent(s) support a nontraditional family member. To include any individual on your FAFSA, you must document that you provide more than 50% of his or her financial support between July 1, 2023 to June 30, 2024. Compete this form to identify if you are eligible to include a dependent in your household.*

	Name of Dependent	Relationship to Student	Dependent Lives with me/us (Yes or No)
Dependent 1
Dependent 2
Dependent 3

Amount of Support

Indicate the amount of monthly support you or your parent (if you are a dependent student) currently provides for the person(s). Do not leave blanks; indicate $0 if none provided.
Rent/Mortgage*
Enter the dollar amount per month that you support your dependent(s). A dollar sign is not needed.
Utilities (Electric/Gas)*
Enter the dollar amount per month that you support your dependent(s). A dollar sign is not needed.
Phone/Cell Phone*
Enter the dollar amount per month that you support your dependent(s). A dollar sign is not needed.
Vehicle (Insurance/Gas/Loan Payment/Maintenance)*
Enter the dollar amount per month that you support your dependent(s). A dollar sign is not needed.
Medical/Health Insurance*
Enter the dollar amount per month that you support your dependent(s). A dollar sign is not needed.
Food*
Enter the dollar amount per month that you support your dependent(s). A dollar sign is not needed.
Personal or Other Expenses*
Enter the dollar amount per month that you support your dependent(s). A dollar sign is not needed.
Specify what personal or other expenses you support.
Amount of Support Total
This field is auto-calculated. Do not enter an amount in this field.
50% of Support Total
This field is auto-calculated. Do not enter an amount in this field.
Amount of Income/Benefits

Indicate the monthly amount of income and/or benefits the person(s) receives on their own behalf. Do not leave any blanks; indicate $0 if none received.
Wages Earned from Work*
Enter the dollar amount per month that your dependent(s) receives. A dollar sign is not needed.
Unemployment/Workers Compensation*
Enter the dollar amount per month that your dependent(s) receives. A dollar sign is not needed.
Social Security Benefits*
Enter the dollar amount per month that your dependent(s) receives. A dollar sign is not needed.
Public Assistance (TANF/SNAP/WIC)*
Enter the dollar amount per month that your dependent(s) receives. A dollar sign is not needed.
Child Support Received*
Enter the dollar amount per month that your dependent(s) receives. A dollar sign is not needed.
Other Sources of Income*
Enter the dollar amount per month that your dependent(s) receives. A dollar sign is not needed.
Specify what other sources of income are received.
Amount of Income/Benefits Total
This field is auto-calculated. Do not enter an amount in this field.
Is 50% of Support more than the Income/Benefits Total?

Yes. Support test for the dependent(s) has been met and individual can be included in household size. You may sign and submit the form.
Is 50% of Support more than the Income/Benefits Total?

No. Support test for dependent(s) has not been met and individual cannot be included in household size. Contact Financial Aid , a new household size worksheet will need to be submitted omitting listed dependents prior to completion of verification.
Certifications and Signatures

Each person signing below certifies that all of the information reported is complete and correct. WARNING: If you purposely give false or misleading information you may be fined, be sentenced to jail, or both. If you are a dependent student, the student and one parent whose information was reported on the FAFSA must sign and date.
Student Signature*

Clear
Date*

MonthDayYear
Parent Signature

Clear
Date*

MonthDayYear
Significant effort has been made to ensure this content meets accessibility guidelines. If you encounter a barrier you can report the barrier at midmich.edu/reportaccessibilitybarrier or contact Financial Aid at (989) 386-6664 or finaid@midmich.edu.

In its commitment to providing a safe environment, Mid Michigan College actively endeavors to broaden our diversity, promote equal opportunity, and prohibit any form of discrimination in its programs, activities, and conditions of admission or employment. Learn more about these efforts and policies by visiting midmich.edu/eeo, midmich.edu/titleix, midmich.edu/securityreport.
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2023-2024 Verification of Support of Dependents

Student Email Verification

Student Status

Amount of Support

Amount of Income/Benefits

Certifications and Signatures