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Application page 4

                                                                                                      Confidential

 

ANNUAL INCOME AND EXPENSES  (2011 Calendar Year)
Home:  Do you own your own home?_______(if no, complete only Monthly payment)
     Monthly payment:  $________________ Unpaid Mortgage:  _________________
     Property value:  $___________________Property taxes:  $___________________

Total Family Income (gross amount for 2011 calendar year.  Circle applicable)
     UNDER $40,000     $40,001-70,000     $70,001-100,000     $100,001-150,000
     $150,001-200,000      $200,001-250,000      Over $250,001

Note:  If student has applied for financial aid, please submit a copy of the College report with student award Scholarship Service (CSS) profile and/or FAFSA application.

STUDENT’S ASSETS OR BENEFITS
    Total earned in last 3 years:  $______________Current Savings:  $_______________ 
     Other assets:  $__________________Social Security benefits: $___________(annual) 
     Anticipated earnings Jan 1, 2012 – Sept 1, 2012:  $___________________________
     Additional sources of funding (e.g. financial plans/trusts) $_____________________

List other scholarships/awards the student has received:
Source                                                                      Amount/yr                  # of years

______________________________________      _______________     _____________ 

______________________________________      _______________     _____________

______________________________________      _______________     _____________

 

State any family circumstances that the Awards Committee should know about (e.g.
divorce, separation, illness, unemployment) that might affect the funding of your
child’s education.  _______________________________________________________


________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

 
I HEREBY DECLARE THAT, TO THE BEST OF MY KNOWLEDGE AND BELIEF, THE FOREGOING STATEMENTS ARE CORRECT

Signature (Parent/ Guardian)_____________________________Date____________2013


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