Web Forms

College financial aid data form

1.Student Last Name: 2.First Name: 3.MI:

Email Address:

4. Student State of Legal Residence: (if more than 5 years, skip to question 5.)

Date you began living in State of Legal Residence: Month/Day/Year: / /

5. Parent State of Legal Residence: (if more than 5 years, skip to question 6.)

Date you began living in State of Legal Residence (less than 5 yrs): Month/Day/Year: / /

6. Dependency:

a. Will you be 24 when filing for financial aid?:

YESNO

b. Are you married? (answer “Yes” if you are separated but not divorced.)

YESNO

c. At the beginning of the school year, will you be working on a master’s or doctorate program
(such as an MA, MBA, MD, JD, PhD, EdD, graduate certificate, etc.)

YESNO

d. Are you currently serving on active duty in the U.S. Armed Forces for purposes other than training?

YESNO

e. Are you a veteran of the U.S. Armed Forces?

YESNO

f. Do you have children who will receive more than half of their support from you between July 1, and June 30?

YESNO

g. Do you have dependents (other than your children or spouse) who live with you and who receive more than half of their support from you, now and through June 30?

YESNO

h. At any time since you turned age 13, were both your parents deceased, were you in foster care or were you a dependent or ward of the court?

YESNO

i. As determined by a court in your state of legal residence, are you or were you an emancipated minor?

YESNO

j. As determined by a court in your state of legal residence, are you or were you in legal guardianship?

YESNO

k. At any time on or after July 1, 2011, did your high school or school district homeless liaison determine that you were an unaccompanied youth who was homeless?

YESNO

l. At any time on or after July 1, 2011, did the director of an emergency shelter or transitional housing program funded by the U.S. Department of Housing and Urban Development determine that you were an unaccompanied youth who was homeless?

YESNO

7. Will you have your first bachelor's degree before July l?

YESNO

8. Have you registered with the Selective Service? YES/NO DOES NOT APPLY

YESNO

9. This will be the student’s:

1st year (never attended college)1st year (previously attended college)2nd year3rd year4th year5th year undergraduate1st-year graduate/professionalcontinuing graduate/professional

10. The student wants financial aid for:

1st yearTwelve Months (includes summer school)

INCOME, EARNINGS & BENEFITS SUMMARY
11. Parents Filing Status:

SingleMarried Filing Joint ReturnMarried Filing Separate ReturnHead of HouseholdWidower with Dependent Children

The following 20___ Income Figures are from:

Completed 1040EZ or 1040ACompleted 1040Estimated 1040EZ or 1040AEstimated 1040Will not file a return

12. Students Filing Status:

SingleMarried Filing Joint ReturnMarried Filing Separate ReturnHead of HouseholdWidower with Dependent Children

The following 20___ Income Figures are from:

Completed 1040EZ or 1040ACompleted 1040Estimated 1040EZ or 1040AEstimated 1040Will not file a return

13. Parents’ Current Marital Status:

SingleMarriedSeparatedDivorcedWidowed

Date of marriage/divorce or separation/death of spouse : Month/Day/Year: / /

14. Students’ Current Marital Status:

SingleMarriedSeparatedDivorcedWidowed

Date of marriage/divorce or separation/death of spouse : Month/Day/Year: / /

15. Number of Family Members in Your Family:

Please list names and birth dates of your siblings:

16. Number of Family Members (Including parents if applicable) who will be College:

20. AGI (IRS 1040, Line 37):

$ $

Tax Information

Parent(s) Student

20a. Father/Student "Gross" Wages Salaries and Tips (W2):

$ $

20b. Mother/Spouse "Gross" Wages Salaries and Tips (W2):

$ $

21. Father/Student Business/Farm Income (Loss): (Include any 1099 Income) (IRS 1040, Lines 12 & 18)

$ $

22. Mother/Spouse Business/Farm Income (Loss): (Include any 1099 Income) (IRS 1040, Lines 12 & 18)

$ $

23. Father/Student Income from Rents, Royalties, Trusts, Estates, Ltd. Partnerships (IRS 1040, Line 17):

$ $

24. Mother/Spouse Income from Rents, Royalties, Trusts, Estates, Ltd. Partnerships (IRS 1040, Line 17):

$ $

25. Interest Income (IRS 1040, Line 8a):

$ $

26. Dividend Income (IRS 1040, line 9a):

$ $

27. Other Taxable Income / (Loss):

$ $

28. Other Non-Taxable Income and Benefits:

$ $

28a. Social Security Benefits:

$ $

28b. Aid to Families with Dependents:

$ $

28c. Child Support RECEIVED for all Children:

$ $

28d. Contributions to 401 K, 403B or other pension plans deducted from GROSS wages, salaries, tips:

$ $

28e. Contributions to IRAs, Keoghs, Self Employment Plans, etc., (IRS Form 1040, Line 32):

$ $

28f. Other Non-Taxable Income and Benefits (Including Earned Income Credit):

$ $

28g. Amount of Child Support PAID by you:

$ $

28h. Amount of Financial Aid RECEIVED by you:

$ $

29. Total Number Tax Exemptions:

$ $

30. Will you itemize deductions next year?

YESNO YESNO

31. If YES, amount of itemized deductions from this year’s Schedule A, Form 1040:

$ $

32. Enter one half of self-employment tax, IRS Form 1040, line 57:

$ $

33. If self-employed, amount of your self employed health insurance deduction:

$ $

34. Amount of Penalties for early withdrawal of savings:

$ $

35. What was the total amount of Alimony Payments:

$ $

36a. Total amount of your Medical/Dental Expenses (including premiums) not covered by insurance?:

$ $

36b. Elementary, junior and high school tuition:

$ $

37. Federal Income Tax IRS Form 1040, line 63:

$ $

ASSET INFORMATION SUMMARY

38. Age of Parents? Father: Mother:

39. Parents' state of legal residence:

40. Date of residency (or birth date of older parent): Month/Day/Year: / /

Parent(s)

Student

VALUE DEBT

VALUE DEBT

41. Cash, Checking and Savings

$ $

$ $

42. Taxable Investments

$ $

$ $

43. Qualified Investments (401K/403B/457/IRA)

$ $

$ $

44. Trust Funds

$ $

$ $

45. 529 College Savings Plans

$ $

$ $

46. Business Assets

$ $

$ $

*Is this a corporation?

YESNO

YESNO

Date Business for started: Month/Day/Year: / /

47. Farm Assets

$ $

$ $

*Do you live on this property?

YESNO

YESNO

48. Investment property

$ $

$ $

*Do you live on this farm?

YESNO

YESNO

Date Farm was purchased: Month/Day/Year: / / Current Market Value:

49. Primary Residence

$ $

$ $

Date Farm was purchased: Month/Day/Year: / / Purchase Price:

Current Market Value: Monthly Mortgage:

STUDENT'S VETERAN'S ADMINISTRATION BENEFITS

1. Do you receive Veteran's Benefits?

YESNO

2. If you currently receive Veteran's Dependent's Educational Assistance Program Benefits:

YESNO

a. Amount per month: $

b. Number of Months:
*Use only the # of months from July 1through June 30 you expect to receive those benefits.

3. If you currently receive Veterans Educational Assistance Program Benefits:

YESNO

a. Amount per month: $

b. Number of Months:
*Use only the # of months from July 1through June 30 you expect to receive those benefits.

4. If you currently receive other Veteran's Administration Benefits.

YESNO

a. Amount per month: $

b. Number of Months:
*Use only the # of months from July 1through June 30 you expect to receive those benefits.