ࡱ> IKHe bjbjhh |*ii  77777KKK84,KO+~*******.1v*7*77 +:77**Z(h)@b:d(*+0O+(1vF1 )17)HL 6@,ll**$O+1 Y :  PAINE COLLEGE Office of Financial Aid Telephone: 706-822-8262 1-800-476-7703 1235 Fifteenth Street Augusta, GA 30901-3182 Fax: 706-822-8691 2024-2025 HOUSEHOLD RESOURCES VERIFICATION - DEPENDENT STUDENT Additional information about your parents financial situation is necessary in order to make a fair and accurate assessment of your eligibility for various financial aid programs. Complete this form to verify how they met their basic 2022 living expenses. Financial support typically comes from direct and indirect sources. Taxable income, such as wages, is an example of direct support. Indirect support may be items provided at no or little cost. A. Dependent Students Information __________________________________________________________ _______________________________________ ____________ Students Last Name Students First Name Students M.I. __________________________________________________________ ________________________________________ _____________ Students Street Address (include apt. no.) Students Social Security Number Students ID # ___________________________ ___ _______ __________ _________________________________________________________ City State Zip Code Students Email Address __________________________________________________________ _______________________________________________________ Students С Phone Number (include area code) Students Alternate or Cell Phone Number B. Parents Source of Income You indicated your parents either had very low income or they did not file taxes in 2022. We understand that they were still able to financially support the family. Indicate your parents source of income in 2022 by selecting the appropriate circle below: O Social Security Income received was received in 2022 in the amount of $ _______________. Attach supporting documentation. O Child Support was received in 2022 in the amount of $ _________________. O Alimony was received in 2022 in the amount of $ _________________. O *Other income received in 2022: Source was _________________________________________________ Amount was $ ___________________ *Explain any Other Income listed above C. Certification and Signatures The person signing this worksheet certifies that all of the information reported on it is complete and correct. WARNING: If you purposely give false or misleading information on this worksheet, you may be fined, be sentenced to jail, or both. The student and a parent must sign and date. _________________________________________________ ___________ _____________________________________ Students Signature Date _________________________________________________ ___________ _____________________________________ Parents Signature Date     ]_`ft ھھکgOg8,h:Sh '5B*CJOJQJ^JaJph/h:Sh '5B*CJOJQJ\^JaJph/h:Sh9x5B*CJOJQJ\^JaJph)h!A5B*CJOJQJ\^JaJph)hB(5B*CJOJQJ\^JaJph)h9x5B*CJOJQJ\^JaJphh>BCJOJQJ^JaJh | CJOJQJ^JaJh;'CJOJQJ^JaJh;'CJOJQJaJh;'CJOJQJaJt    \ g ' $7$8$H$a$gde 7$8$H$gd9x $7$8$H$a$gd9x 0^`0 &dP       % Կ}eP8##P)htOh9xB*CJOJQJ^JaJph/htOh9x5B*CJOJQJ\^JaJph)htOh9xB*CJOJQJ^JaJph/h:Sh9x5B*CJOJQJ\^JaJph)hB(5B*CJOJQJ\^JaJph)h!A5B*CJOJQJ\^JaJph/h:Sh '5B*CJOJQJ\^JaJph)htOh9xB*CJOJQJ^JaJph/h:Sh9x5B*CJOJQJ\^JaJph&hSS5B*CJOJQJ^JaJph % [ \  d f g l p y  %'Wbشؐ~l~~#h B*CJOJQJ^JaJph#h%HB*CJOJQJ^JaJph#h>BB*CJOJQJ^JaJph#h:SB*CJOJQJ^JaJph#hwB*CJOJQJ^JaJph#h9xB*CJOJQJ^JaJph)htOh9xB*CJOJQJ^JaJph#h+qB*CJOJQJ^JaJph)' 12~-UV$d &d 7$8$H$N P gd9x 7$8$H$gd9x~ 125SWj}~Һҥ~~raSaarraSaHrrrah:ShwCJaJhB(CJOJQJ^JaJ h:ShwCJOJQJ^JaJh:Shw5CJaJ#hB(B*CJOJQJ^JaJph)h:ShwB*CJOJQJ^JaJph)h h9xB*CJOJQJ^JaJph/h hw5B*CJOJQJ\^JaJph/h h9x5B*CJOJQJ\^JaJph)hwh9xB*CJOJQJ^JaJph-TUV~ᵝs^LL7)htOhwB*CJOJQJ^JaJph#h:SB*CJOJQJ^JaJph)h:ShwB*CJOJQJ^JaJph)h:Sh:SB*CJOJQJ^JaJph)h:Sh9xB*CJOJQJ^JaJph/h:Sh9x6B*CJOJQJ]^JaJph)h:ShwB*CJOJQJ^JaJphh:Shw5CJaJh:ShwCJaJ h:ShwCJOJQJ^JaJhB(CJOJQJ^JaJ<]^˽h,/:hdjhdUh;'5CJ\h>B5CJ\aJh9x5CJ\aJh9xCJaJh h9x5CJ\aJh h:S5CJ\aJ htOh9xCJOJQJ^JaJ)htOh9xB*CJOJQJ^JaJph% $7$8$H$Ifgd/<77//$a$gdngd9xkd$$Ifl~ֈ8 /%RRSRRS04 layt/<]^gdDgd/~gd9xz+p,p-p.p1h/R 4567:p/ =!"#h$% $$If!vh#vR#vS#vR#vS:V l~05R5S5R5S4yt/x02 0@P`p2( 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p8XV~ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@66666_HmH nH sH tH @`@ NormalCJ_HaJmH sH tH DA D Default Paragraph FontVi@V  Table Normal :V 44 la (k (No List HH  Balloon TextCJOJQJ^JaJDBD Body Text$a$CJOJQJ^Jfof 9xDefault 7$8$H$1B*CJOJPJQJ^J_HaJmH phsH tH # 9x Table Grid7:V0CJOJPJQJ^JaJ@2@ DHeader  H$ mHsHtH6/A6 D Header CharCJaJ@ R@ D0Footer  H$ mHsHtH6/a6 D0 Footer CharCJaJPK![Content_Types].xmlN0EH-J@%ǎǢ|ș$زULTB l,3;rØJB+$G]7O٭V (BO)MBT.$@0H!A>풠Uc-zD[&!rX=}zC0` ި%.]Ssd--7 +fOZեrŵVœ\lji2ZGwm-3˵j7\ Uk5FҨ-:xRkcr3Ϣ+9kji9OP Et-j|#p;E=Ɖ5Z2sgF=8 K}*7c<`*HJTcB<{Jc]\ Ҡk=ti"MGfIw&9ql> $>HmPd{(6%z:"'/f7w0qBcF6f Iöi1(\}B5ҹ~Bcr6I;}mY/lIz1!) ac 1fm ƪN^I77yrJ'd$s<{uC>== Ƌ(uX=WA NC2>GK<(C,ݖm: &-8j^N܀ݑ$4:/x vTu>*ٞn{M.Ǿ0v4<1>&ⶏVn.B>1CḑOk!#;Ҍ}$pQ˙y')fY?u \$/1d8*ZI$G#d\,{uk<$:lWV j^ZơSc*+ESa1똀 k3Ģxzjv3,jZU3@jWu;z \v5i?{8&==ϘNX1?  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