Financial Aid Low Income Statement

Please provide a general idea of how you were able to afford food/shelter/utilities for yourself and any dependents for the indicated Tax Year. Be sure to include any assistance and/or programs (example: lived with friends/family, SNAP, Social Security or Disability benefits, etc.), but you do not need to include any specific amounts.

You are considered a dependent student unless you fit any of the following requirements:

You are 24 or older
You are married
You have a child
You are a veteran

What is your dependency status?(Required)

If you are not sure, please see the 'What determines dependency' section to the left.

I am a dependent student.

I am an independent student.

As a dependent student, you parent(s)/guardian(s) MUST be the ones to fill out this form.(Required)

I understand

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Date

MM slash DD slash YYYY

Student Name(Required)

First Last

Bellevue College Email(Required)

ctcLink ID(Required)

If you do not provide us your ctcLink ID number we cannot upload your information to your file.

Tax Year(Required)

Instructions - Choose all that apply

I was able to afford food, shelter, and utilities for myself and my dependents (if applicable) by:(Required)

Social Security - Retirement

Social Security - Disability (SSDI)

Social Security - Survivors

Social Security - Supplemental Security Income (SSI)

Veteran's Benefits

Food Assistance Program(s) [Please specify below]

Housing Assistance Programs(s) [Please specify below]

Utilities Assistance Program(s) [Please specify below]

Lived with Family/Friends [Please specify below]

Lived off savings at the time

Lived off financial aid

Other [Please specify below]

Additional Information

Please provide additional information based on your answers above.

If you checked that you were enrolled in Food Assistance Program(s), please specify the program(s):(Required)

Example: SNAP, EBT, food stamps, etc.

If you checked that you were enrolled in Housing Assistance Program(s), please specify the program(s):(Required)

This may include military housing and homeless shelters.

If you checked that you were enrolled in Utilities Assistance Program(s), please specify the program(s):(Required)

Example: Low-Income Home Energy Program (LIHEAP), Gov. Cell Phone, etc.

If you checked that you were living with Family/Friends, did that include financial assistance?(Required)

Other than housing - includes food, utilities, and other bills.

If you checked Other, please provide a brief statment explaining any other programs, assistance, and/or income you received that isn't listed.(Required)

Any other source of aid or income.

Warning:(Required)

If you or your student receive federal student aid based on incorrect or fraudulent information, you or your student will have to pay it back. You may also have to pay fines and fees. If you or your student purposely provide false or misleading information on the FAFSA form, you may be fined up to $20,000, sent to prison, or both.

I understand and the information provided is correct and true to the best of my knowledge

Last Updated January 24, 2025

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