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RETURN TO: Office of Financial Aid & ScholarshipsCal Poly Pomona3801 W. Temple Ave.Pomona, CA 91768-4008(909) 869-3700 Phone(909) 869-4757 FAX

Name of Financial Aid Applicant (please print)

Last First Middle Bronco Number:

2014 2015HOUSEHOLD SIZE/STATUS VERIFICATION FORM

Your application was selected for verification. Complete the chart below and return the completed and signed form to our office. Please keep in mind that incomplete forms and missing requested documents will create delays in processing your financialaid award.

DETERMINE who is considered a family member. Was your parents signature required on the FAFSA?

Section A: Tell Us About Your Family Size

Parent Signature was required on FAFSA (Dependent) No Parent Signature was required on FAFSA (Independent)

Include the following in the chart: Yourself The parent(s) you live with (include step-parent) OR if not

living at home, the parent(s) whose information was usedon the FAFSA.

Your parents other children ONLY IF : The parent listed will provide at least half of their

support from July 1, 2014 to June 30, 2015, OR The children would be required to provide parent

information completing the FAFSA. Other people currently living with your parent(s) for whom

your parent(s) currently provide and will continue toprovide at least 51% of their support from July 1, 2014 toJune 30, 2015.

Include the following in the chart: Yourself Your spouse if you are married Your children ONLY IF you will provide at least 51% of

their support from July 1, 2014 to June 30, 2015. Other people currently living with you for whom you

currently provide and will continue to provide at least 51%of their support from July 1, 2014 to June 30, 2015.

DO NOT LIST CHILDREN FOR WHOM YOU PAY CHILD SUPPORT.

Full Name Age Born beforeJanuary 1, 199 1

(Yes or No)

Relationship to Student Name of College

STUDENT SELF CAL POLY POMONA

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Name of Financial Aid Applicant (please print)

Last First Middle Bronco Number:

Section B: Student Information

Where will you be living while attending Cal Poly Pomona (check one):

residence hall with parents off-campus/village suites

Indicate if you are a (check one):

first time freshmen transfer continuing

Indicate if your educational status (check one):

undergraduate teaching credential masters doctoral

2nd BA/BS Degree 2 nd MA/MS Degree

Section C: Sign this form

By signing this, I certify that all the information reported to qualify for student financial aid is true, complete and accurate.I give permission to the Office of Financial Aid & Scholarships to obtain secondary verification if necessary.

Signature (Student) Date

Parent/Step-Parent Signature (If signature was required on FAFSA) Date

Visit us online at www.csupomona.edu/~financial-aid Page 2

http://www.csupomona.edu/~financial-aidhttp://www.csupomona.edu/~financial-aidhttp://www.csupomona.edu/~financial-aidhttp://www.csupomona.edu/~financial-aid