Complete this form electronically, using Adobe Reader.

* You must type in the

students name and 8-Digit
UFID before printing! SFA
cannot accept digital
signatures.

Division of Enrollment Management

Office for Student Financial Affairs

16/17
S107 Criser Hall PO Box 114025
Gainesville, FL 32611-4025
352-392-1275/392-1275 TDD
352-392-2861 Fax www.sfa.ufl.edu

Clear Form

* UFID

Dependent Student 2016-2017

Household Size & College Enrollment Statement
3196

7616

Student's Name

Amber Nguyen

Please provide information on your household size AND the members of the household who will be enrolled in college
during the 2016-2017 school year.
Include in your household:

yourself and your parent(s), even if you do not live with them. If your parent is widowed or single, divorced or
separated and do not live together, include only your responsible parent. If both parents live together but are not
married, include both parents. If your responsible parent has remarried, include both your parent and stepparent.
your parents' other children, if your responsible parent will provide more than half their support from July 1, 2016
through June 30, 2017.
other people if they now live with your parents, your parents provide more than one-half of their support, and will
continue to do so from July 1, 2016 through June 30, 2017.

List additional family members on reverse side if necessary.

HOUSEHOLD SIZE
Relationship to the student

Name
1.Amber Nguyen

Age
19

STUDENT APPLICANT

2.Alexander Nguyen

Brother

22

3.Thai Nguyen

Father

52

4. Yen Nguyen

Mother

50

5.
6.
COLLEGE ENROLLMENT

Per federal regulations, do not include your parents in the college enrollment information.
Include others if they will attend, at least half-time in 2016-2017, a program that leads to a college degree or
certificate & are included in the household size.
Do not include high school students who are dual-enrolled.
Each school listed must be eligible to participate in any of the federal student aid programs.

Name

College Name, City & State

Class & College (Major)

1. STUDENT APPLICANT

University of Florida, Gainesville, FL

2CALS(Nut.Sci.)

2. Alexander Nguyen

University of West Florida, Pensacola, FL

4(Int.'l Stud.)

3.
I certify under penalty of perjury that the information listed above is correct and complete to the best of my knowledge.

06/15/16

06/15/16
Student's Signature

Date

Parent's Signature

Date

FOR SFA USE ONLY

DHSZ ______________

UFID ___________________ 6 49

DCOL ______________

Name ______________________

*31967616-649*
6

49

veri-16DCOL-2/16