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HOME FINANCIAL SERVICES FINANCIAL AID 2011 - 2012 Low Income Form

2011 - 2012 Low Income Form

Dear Financial Aid Applicant,
When reviewing your 2011/2012 Student Aid Report, we noted that a low or zero 2010 income was reported by you or your parent(s). Clarification as to how you lived on this income is needed. Please answer the questions below and return this form to the Bellevue University Financial Aid Office WITHIN 14 DAYS. This information is required prior to the processing of your financial aid.

If you have any questions regarding the completion of this form, please contact the OneStop Service Center at (800) 756-7920 / (402) 293-2000, option 0 or by email at OneStop@bellevue.edu. Thank you for your cooperation and prompt response.

2010 Expenses (indicate approximate annual amount)

$

Did you receive housing assistance?

Did you receive fuel assistance?

$

Did you receive food stamps?

$

Did you receive medical assistance?

$

Did you receive daycare assistance?

$
$
$

2010 Income Sources (indicate approximate annual amounts)

$
$
$
$
$
$
$

Certification

By signing this worksheet, I (we) certify that all the information reported to qualify for Federal student aid 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.

$
$
$

Please ensure your email address is formatted correctly in order to receive a courtesy copy.

Your Name

Your Email

Their Name

Their Email

Email Subject (optional)

Email Message (optional)

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