Section 1: Student Information
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.
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.)
2011 Tax Form:
Will Not File
Will Not File
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.
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.
Soc. Sec. Benefits
Child Support Received
Military Subsistence Allowances
Section 4: Asset Information
Age of oldest parent:
Cash Savings: This includes cash and the current balance in your savings and checking accounts.
Real Estate & Investments Value: This 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 & Investments: The amount you owe on real estate (excluding your principal residence) and investments.
Business Value: The amount that your business is worth today. Include the market value of land, buildings, machinery, equipment, inventories, etc.
Debt Against Business: The amount that is owed on the business. Include only the present mortgage and related debts for which the business was used as collateral.
Farm Value: The 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 Farm: The 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 GPA:
Grade point average (GPA): Your overall GPA is calculated from all classes attempted.
H.S. Core Academic GPA:
The Core Academic GPA does not in- clude non-academic courses.
SAT (Best total of all 3 sections):
Section 6: Application Status
This form will be emailed to the College's Financial Aid Officer, Alisa Polk.
You should receive an answer within two weeks time.