2023-2024 Form 56 Legal Dependent Verification

2023-2024 Form 56 Legal Dependent Verification
Campus Location*
A. Student Information
Name

First NameLast Name
Student ID
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.
B. Dependent Information
Please list below the name, age, date of birth, and relationship to you of YOUR dependent(s). Dependents are individuals who you will support between July 1, 2023 and June 30, 2024. Include your children (and any unborn child if the child will be born before or during the award year) that will receive more than half their support (50%) from you. Include other people only if they now live with you, will receive more than half their support (50%) from you, and will continue to receive this support between July 1, 2023 and June 30, 2024. (Support includes money, gifts, loans, housing, food, clothes, car, medical and dental care, and similar expenses.)

Supporting Documentation
Attach documentation (copy of most recent check stub, or AFDC/TANF check; current Notice of Action form from your employer; canceled checks or other proof of child support paid; WIC program eligibility notice; Medical eligibility notice) to verify your claim of support.*

Cancelof
If you do not provide more than half (50%) of the support for this dependent and/or do not have supporting documentation, please read and initial the following statement.
I certify I do not have a legal dependent (other than a spouse) as defined for financial aid purposes. I understand I may be required to provide parental information before my financial aid eligibility can be determined.

Clear
Student Signature
By signing this document, I certify that the information provided above is complete and correct. I also understand that purposely giving false or misleading information may result in me being fined, sentenced to jail, or both.*

Clear
Date

MonthDayYear
Date
Do you have questions or need help with your Financial Aid?

Financial Aid Office

3240 Fort Rd., Toppenish, WA 98948 | (509) 865-8502 | financial_aid@heritage.edu

Please list all source(s) and amount(s) of support for dependent(s) listed above.

C. Dependent Living Situation

Where do the dependent(s) listed above live?
Please select one of the following options:
If other, please provide explanation and individual's name, Social Security Number, and address.
D. Sources of Support for Dependents
Should be Empty:

A. Student Information