Section 1: Student Information
Name:
Email:
Address:
City:
State:
Zip:
Phone:
Birth Date:
U.S. Citizen?
Yes
No
Married?
Yes
No
Section 2: Household Information
Marital Status of Parents
If your parents are divorced and your custodial parent is remarried, the parent status should indicate Married. The questions pertain to only your custodial parent(s). Do not include information on a parent or stepparent with whom you do not reside.
:
Single
Married
Separated
Divorced
Widowed
Family Size
The number in the family, including the student.
:
Number in College in 2013-14
The number in college should include only those family members who will be enrolled full time in an
accredited institution during the specified academic year.
:
Section 3: Income
(
Please note that the estimate given to you will be based on last year’s income, but that the actual award for the 2013-14 year will be based on your 2012 income/tax returns.)
Parents
Student
2011 Tax Form:
1040A
1040EZ
1040
Will Not File
1040A
1040EZ
1040
Will Not File
Exemptions:
2011 Gross Adjusted Income
Your total income minus any adjustments.
:
U.S. Income Tax Paid
This includes income tax paid. It is not the amount of tax withheld on your W-2, but the actual federal income tax paid. Make sure this amount does not include any FICA tax paid.
:
Income earned from work Include the "wages, salaries, tips, etc.," from the IRS Tax Forms. :
(father)
(mother)
Untaxed income This is untaxed income and benefits, such as Social Security benefits, AFDC, child support received, wel-
fare, pensions, military subsistence allowances, and veterans benefits. :
Type:
Soc. Sec. Benefits
AFDC
Child Support Received
Welfare
Pensions
Military Subsistence Allowances
Veterans Benefits
Section 4: Asset Information
Age of oldest parent:
Parents
Student
Cash SavingsThis includes cash and the current balance in your savings and checking accounts. :
Real Estate & Investments ValueThis does not include your family's principal residence. Include rental property, land, and second or summer homes. Investments include trust funds, money market funds, mutual funds, certificates of deposit, stocks, bonds, other securities, installment and land sale contracts, etc. Do not include the value of life insurance and retirement plans (pension funds, annuity, IRA and Keogh plans). :
Debt Against Real Estate & InvestmentsThe amount you owe on real estate (excluding your principal residence) and investments. :
Business ValueThe amount that your business is worth today. Include the market value of land, buildings, machinery, equipment, inventories, etc. :
Debt Against BusinessThe amount that is owed on the business. Include only the present mortgage and related debts for which the business was used as collateral. :
Farm ValueThe amount that your farm is worth today. Include the market value of land, buildings, machinery, equipment, inventories, livestock, etc. Do not include a family farm if it is your principal residence. :
Debt Against FarmThe amount that is owed on the farm. Include only the present mortgage and related debts for which the farm was used as collateral. :
Education Saving Plan:
Section 5: Academic Profile
H.S. Overall GPAGrade point average (GPA): Your overall GPA is calculated from all classes attempted. :
H.S. Core Academic GPAThe Core Academic GPA does not in- clude non-academic courses. :
Class Rank:
/
SAT (Best total of all 3 sections):
or ACT:
Section 6: Application Status
Status:
Not applied
Early Action
Regular
College Residence:
Resident/On Campus
Commuter/Off Campus
Comments/Questions:
This form will be emailed to the College's Financial Aid Officer, Alisa Polk.
You should receive an answer within two weeks time.