SPOUSE IGNIFICANT OTHER FORM - https://apps.ksbe.edu

SPOUSE/SIGNIFICANT OTHER FORM

Financial Aid and Scholarship Services

N Ho`okama a Pauahi

2018-2019 Academic Year

Applicant Last Name

Applicant First Name

Spouse/Significant Other Data Name of Spouse/Significant Other Phone Number E-mail Address Occupation Completed (Submit 1040, 1040A or 1040EZ Form) Not required to file (Submit a Non-Tax Filer Form)

Income/Support Received From

Alimony

Cash Received from family, friends and/or others Child Support Disability Benefits (including Children)

Food Stamps (SNAP)

Living and Housing Allowances provided by employer Pension/IRA/Retirement Benefits (Distributions Only) Scholarships, Federal Grants/Loans (Winter 2016, Spring 2016, Summer 2016, Fall 2016) Section 8 Housing Social Security Benefits/SSI (including children)

2016 Income (Spouse/Significant Other)

Annual Total ? 2016 Income/Support Received From

$

Temporary Disability Insurance (TDI)

$

Unemployment Benefits

Veterans Benefits: Educational

$

Veterans Benefits: NonEducational

$

Wages (from employer, cash for labor/services)

$

Welfare (TANF)

$

Workers Compensation

$

Other Income, please specify

$

Other Income, please specify

$

Annual Total ? 2016 $ $

$ $

$

$

$

$ $

Assets (Spouse/Significant Other)

Asset Type

Current Market Value

Checking/Savings Accounts

$

Investments (stocks, CDs, trusts, money market, etc.) $

Business

$

$

Farm

$

$

Other Real Estate Property

$

$

Current Debt

Page 1 of 2

Applicant Last Name

Applicant First Name

2016 Expenses (Spouse/Significant Other)

Expense Type

Annual Total Paid in 2016

Medical/Dental Expense Paid (out of pocket)

$

Child Support Paid

$

Family Member Listing (Include: spouse/significant other and all dependent children)

If more space is needed, use Explanation/Special Circumstances section below

Full Name

Relationship to Applicant

Age

Name of School (2018-2019)

Grade Level (2018-2019)

Explanation/Special Circumstances Use this space to explain any unusual expenses such as loss of employment, loss of one-time income, high medical/dental expenses or special circumstances. Also give information for any outside scholarships you have

been awarded. If more space is needed, use sheets of paper and submit them with this form.

Certification

I/We hereby certify that the above statements are true to the best of my/our knowledge and agree to furnish proof and other documentation as requested. I/We acknowledge that failure to disclose any requested information, or providing inaccurate, incomplete and/or false or misleading information, may result in disqualification.

Student Signature

Date

Spouse's/Significant other's Signature

Date

COMPLETE AND SUBMIT THIS FORM with your supporting documents to:

KS Applicant Services Center 567 South King Street, Suite 102 Honolulu, HI 96813

Phone: (808) 534-8080 Fax number: (808) 523-6289 E-mail address: finaid@ksbe.edu

Page 2 of 2

 ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download