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
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