Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Download Scholarship Financial Need Information
Transcript
Scholarship Financial Need Information For scholarship applications in 2015 Student Information Last name _____________________________________ First name ____________________________ Middle initial ______ Address _______________________________________________________________________________________________ City ________________________________ State ____________ Zip Code ____________ Phone ____________________ Birthdate _________________________________ U.S. Citizen? Yes ___ No ___ If not, describe status _______________ How much education will you have completed when you begin the 2015-2016 school year? _____________________________ Describe any tuition assistance you expect to receive from July 1, 2015 through June 30, 2016, including armed service education benefits and tuition assistance from employers ________________________________________________________ ______________________________________________________________________________________________________ Student Status Answer the following questions carefully Yes No Were you born before January 1, 1992? ____________ ____________ Are you a veteran of the U.S. Armed Forces? ____________ ____________ In 2015-2016 will you be working toward a degree beyond a bachelor’s degree? ____________ ____________ Are you married? ____________ ____________ Are you an orphan or a ward of the court, or were you a court ward until age 18? ____________ ____________ Do you have legal dependents other than a spouse? ____________ ____________ Household Information If you answered Yes to any question above, complete Student Household questions at left and the Student financial questions on following page. If you answered No to every question above, complete Parent(s) Household questions at left and both the Student and Parent financial questions on following page. Student Household Parent(s) Household Current marital status: Single ___ Current marital status: Single ___ Married ___ Divorced ___ Married ___ Divorced ___ Separated ___ Widowed ___ Separated ___ Widowed ___ How many legal dependents other than a spouse receive more than half their support from student and student’s spouse? ___ How many legal dependents other than a spouse receive more than half their support from this household? ___ Page 1 of 3 How many of the above dependents will be college students during the 2015-2016 school year? ___ 20150117 Scholarship Financial Need Information – Page 2 Student’s last name _____________________________________ First name ___________________ Middle initial ______ Complete the student column below. Also, if asked to complete the Parent(s) Household questions on preceding page, complete the Parent(s) column below. Financial data from most recent Federal Income Tax Return Student Parent(s) Year covered by most recent Federal Income Tax Return _____________ _____________ Number of exemptions claimed _____________ _____________ Adjusted gross income $____________ $____________ Student’s W-2 earned income $____________ N/A Student’s spouse’s W-2 earned income, if any $____________ N/A N/A $____________ Net farm/ranch income included in adjusted gross income $____________ $____________ Untaxed income: a. Earned Income Credit $____________ $____________ b. Social Security benefits $____________ $____________ c. Aid to Families with Dependent Children $____________ $____________ d. Child Support income $____________ $____________ N/A _____________ Cash, savings and checking accounts total value $____________ $____________ Farm/ranch real estate value $____________ $____________ Farm/ranch real estate debt $____________ $____________ Farm/ranch equipment, livestock, crops value $____________ $____________ Farm/ranch equipment, livestock, crops debt $____________ $____________ Is a farm or ranch used as principal residence? Yes___ No___ Yes___ No___ Business value $____________ $____________ Business debt $____________ $____________ Other real estate and investments value (exclude home & retirement plans) $____________ $____________ Other real estate and investment debt (exclude home & retirement plans) $____________ $____________ Parents’ W-2 earned income Financial data about Assets and Debts at this time Age of your older parent Certification and Signature(s) By signing you certify that the information supplied is accurate to the best of your knowledge. Student signature __________________________________________________________ Date ______________________ Parent signature (if parent information included) ________________________________________ Date ______________________ Page 2 of 3 20150117 Scholarship Financial Need Information – Page 3 Student’s last name First name __________________ Middle initial ______ College or University student expects to attend: Location of College or University: Projected Expenses Related to Education for School Year 2015-2016 Tuition & Fees Room & Board Books and Supplies Personal Expenses Transportation Total Projected Expenses Projected Sources of Funds to Pay for Expenses for School Year 2015-2016 Work earnings Savings Parents/Relatives Scholarships awarded Grants received Loans Other (Describe) Other (Describe) Total Projected Sources of Funds Projected Expenses and Projected Sources of Funds do not necessarily need to be the same amounts. By signing you certify that the above projected expenses and sources of funds are reasonable estimates at this time and nothing significant has been purposefully omitted to the best of your knowledge. Student Signature Page 3 of 3 Date 20150117
