Student Income Statement

(For Tax Year 2006)

STUDENT NAME KSU ID

WHY YOU ARE BEING ASKED TO FILL OUT THIS FORM:

The income and assets you listed on the FAFSA appear to be insufficient to
meet basic living expenses (housing, food, etc). Please itemize your expenses and
resources for 2006 below. (expenses: whether or not you actually paid for it)

Every line should have a number on it; even if it is ZERO !

However, if you list “0” for an expense, you will need to explain it on the back of his f orm.

Expenses for 2006

Housing and Utilities $
Tuition and Fees
Books and Supplies
Food (include dining out)
Clothing
Transportation (gas, repairs)
Auto Payment
Car Insurance
Health Insurance
Recreation/Entertainment
Other (Specify)

TOTAL EXPENSES $

Resources for 2006

$
Student Wages (GROSS)
Spouse’s Wages (GROSS)
Resources from Parents
Resources from Other Relatives
Interest & Divided Income
AFDC
Veterans’ Benefits
Soc. Security/Disability Benefits
Other Income (Specify Source)
1.
2.

TOTAL RESOURCES $

Note: If your TOTAL EXPENSES are more than your TOTAL RESOURCES,
You will need to give a detailed explanation of how you met your expenses on the back
I (We) hereby swear or affirm that all information on this form and any attachment hereto is true, complete, accurate to the best of
my (our) knowledge. I (We) understand that any false statements or misrepresentation will be cause for denial, reduction,
withdrawal, and/or repayment of financial aid, and may subj ect the filer(s) to a fine or imprisonment or both, under provisions of
the United States Criminal Code. I(We) will, if requested, provide documentation certifying the above expenses and resources.

Signatures are required for all persons reporting information above.

X Date:

X Date:

X Date: