UMUC
Financial Aid Feedback Survey
2007-2008
Low Income Statement
First name:  Middle initial: Last name:
 
Student ID number: 
 
The information submitted on this form is for:

Student      Mother      Father      Spouse

Please submit separate documents for parent or spouse.  

A review of your financial aid application indicates that your total family income was extremely low. Please complete the information below to explain how you and those in your household met expenses throughout 2006. List all amounts as totals for the 2006 year.
 
Income:  
Work
(Attach copies of all W-2s):
Cash from family and friends:
AFDC/TANF:
Child support received:
Social Security benefits:
VA benefits:
Disability benefits:
HOC/Food stamps:
Worker's Compensation:
Other:  
Other:  
Total:
Expenses:  
Housing:
Food:
Transportation:
Personal expenses:
Day care:
Other:  
Other:  
Other:  
Other:  
Total:
 
 
An explanation is required below to consider this form complete. Please explain the difference in the total amounts listed for your income and expenses, such as for what purpose was the cash received from friends and family used? Please attach supporting documentation, including copies of your 2006 federal taxes or, if you did not file tax returns, copies of your W-2s.
 

Do not enter text beyond the limits of the box as you will not be able to read that information when you print the form. Press "Return" or "Enter" at the end of each line to advance to the next.
 

I certify that I have completed all questions and that the information submitted on this form is complete and accurate. I understand that summary dismissal is the penalty for falsification of that information. I also understand that if I purposely give false or misleading information on this document, I may be fined up to $10,000, sent to prison, or both.

I also understand that I am responsible for and agree to pay all charges I incur at UMUC, and that if I withdraw, I must do so in accordance with the policies and procedures in the Schedule of Classes for the semester in which I am enrolling. I understand that if my account becomes delinquent, my requests for services (e.g., transcripts, diplomas, official evaluations) will be denied until all debts are paid and I will be liable for collection costs.

 
 
line
Student signature                       Date Spouse's signature                       Date
   
   
line
Mother's signature                     Date Father's signature                         Date
 
Please fill out the form completely, print it, and mail or fax it to:
      University of Maryland University College
3501 University Boulevard East
Adelphi, Maryland 20783 USA
 
  • Undergraduate students—mark your envelope to the attention of Financial Aid.
  • Graduate students—mark your envelope to the attention of Financial Aid.
  • Student Financial Services fax: (301)985-7462