HEOP Pre-Eligibility Form

St. Lawrence University - HEOP Program Form

Thank you for completing the HEOP Pre-Eligibility Form; this will assist us greatly in processing your application. For any question that is not applicable to you and your family, please indicate NA in the box so we know it has been reviewed.

example: 1 Main Street, Apt. 24
Has your home address been in the State of New York for at least one year?
Are you a ward of the court, have a legal guardian or are currently under foster care?

Household Information

Please provide the following information for all members living in your household: Name, Age, Relationship to Applicant, is person employed or attending college?

(if living in household)
(if living in household)
(if employed)

Required Documents

Please note you will need to provide a signed copy of parent and applicant's 2015 Federal tax returns (if filed) and a copy of all W2s, or an IRS tax transcript of your 2015 Federal tax return and a copy of all W2s.

YesNo
Help with rent (housing assistance)? *
Cash Grant? *
Food Stamps (SNAP)? *
Medical? *
Other? *
Check all that are applicable. If you marked yes to any above, please provide a statement from the Department of Social Services from which benefits were received during 2015.
YesNo
Social Security Income (SSI)? *
Social Security Disability? *
Social Security Survivors Income? *
If yes, please provide a copy of the 2015 benefit verification letter from SSI. This letter may be accessed at www.socialsecurity.gov/myaccount or by calling 1-800-772-1213.
If yes, please submit the statement (Form 1099) from the Social Security Administration reporting the benefit total for 2015. Please provide a copy of the 2015 benefit verification letter from Social Security. This letter may be accessed at www.socialsecurity.gov/myaccount or by calling 1-800-772-1213.
YesNo
Disability *
Unemployment *
Veterans Non-Edu Benefits *
Living Allowances *
Workers Compensation *
Untaxed Pensions *
Any other income received in 2013 not reported on this form *
Please select all that are applicable.

Household Assets

Please report information as of the day you are completing this form.