ˇ CAYUGA COMMUNITY COLLEGE ˇ
Financial Aid Office ˇ 197 Franklin Street, Auburn NY 13021ˇ FAX 315-252-2185
Auburn 315-255-1743 ext. 2470 ˇ Fulton 315-592-4143 ext. 3004
Student Name ________________________________ Social Security #: __________________
Banner ID Number C___________________________
On your financial aid application you indicated that you have children or other dependents that live with you and receive more than half of their support from you. Since this statement is the basis for your independent status it is necessary for you to validate your response. Please answer the following questions. Additional information may be requested.
What is the name, birth date and relationship of your dependent?
Name:___________________________ Birth Date:_________ Relationship:______________
Does the dependent live with you? __________________
If yes, list name and relationship of other members of the household where you live:
Name: ____________________________ Relationship: __________________
Name: ____________________________ Relationship: __________________
Who claimed you as a tax exemption in 2007? __________________
Who will claim you as a tax exemption in 2008? __________________
Who claimed your dependent as an exemption in 2007? __________________
Who provides medical insurance for you? __________________
Who provides medical insurance for your dependent? __________________
What is the amount of child support received in 2007? __________________
What is the estimated annual child support you will receive in 2008? __________________
__________________________________________ _____________________
Student Signature Date
Please return this form along with a signed copy of your 2007 Federal Tax Return to the Financial Aid office at Cayuga Community College.
DOTS/jgm
01/08