Criteria for Eligibility
Please select ALL that apply.
Student Information
Subsidy Request Information
Number of credit hours in which you will be enrolled each semester
Partner's Information
Number of credit hours in which your partner will be enrolled each semester
Dependent Child Information
Day care provider address
Second Dependent Child Information
Day care provider address
Third Dependent Child Information
Day care provider address
Other Sources of Income
Initial Each Statement of Understanding
By typing my initials next to each Statement of Understanding, I confirm that all information included in this form is true and complete.
Tax Information
PLEASE BLACK OUT ALL SOCIAL SECURITY NUMBERS
Domestic Students Should Submit
copies of their, and if applicable, their spouse's or partner’s signed federal income tax returns from the previous year (1040, 1040A, 1040EZ, 1040NR, 1040NR-EZ, or Form 8843) and/or a previous year Non-Filing Statement Submit the Non-Filing Statement if you/your spouse/partner were not required to submit tax returns based on IRS income requirements.
International Students Should Submit
submit copies of their and their spouse's or partner’s signed federal income tax returns from the previous year (1040, 1040NR, 1040NR-EZ, or Form 8843). U.S. Internal Revenue Service guidelines require all international students to file a tax return. If you did not reside in the United States last year, please submit a statement to that effect.