Client Name:
Parent Email Address:

(For parent correspondence)


Section One: Student Information

1:
Student’s Name:

First

Middle

Last

2:
Street Address:

Enter the address

City:

State:

Zip:

3:
Home Phone:

4:
Student’s SSN: *

5:
Student’s Date of Birth: *

6:
Student’s High School:

PublicPrivate

7:
Student’s H.S. Grad year:

8:
Driver’s License:

License No.: *

State: *

9:
Is the student a US citizen?: *
YesNo

If no, enter Alien Reg. No.



10:
Is the student married?:
YesNo

if yes, please provide information below

11:
Has the student ever been convicted of a drug offense?: *
YesNo
12:
Date of State Residency:
13:
Standardized Test Scores: *

SAT Verbal/Critical Reading:

SAT Math:

SAT Writing:

ACT:

14:
If the student is male and is at least age 18, is he registered with Selective Service?: *
YesNo



Section Two: Student Income Information

Estimates are perfectly acceptable. You can use the previous year’s figures as reference.

15:
Student’s Tax Status for 2017:
Already filedWill file, but have not completedWill not file
16:
Student’s Earned Income: (W-2 Wages)
17:
Student’s Unearned Income: Interest, Dividends, etc.
18:
Student’s Adjusted Gross Income:
19:
Itemized Deductions: IRS Form 1040 – Line 40 (if any)
20:
Untaxed Income & Benefits:
a.
Student’s Contribution to

IRA/Tax Deferred Plans:

b.
Social Security Benefits:
c.
Other Untaxed Income:

(Specify)

Section Three: Student’s College Choices

College/University:
City
State/Prov.

Comments or Special Circumstances

Types of schools younger siblings are interested in or potentially going to attend.

If no remark, then the planning for those children will be the same as the student we are planning for.

23. On a MONTHLY BASIS: Your student’s college expenses? *
Please do not put zero
24. On a MONTHLY BASIS: What does it cost to run your household? (i.e. Expenses)
Please do not put zero

Section Four: Parent & Family Information

Father’s Information

25:
Father’s Full Name:
27:
Father’s Date of Birth:
29:
Father’s SSN:
31:
Father’s Occupation:
33:
Father’s Employer:
26:
Number of years with employer:
28:
Work Phone Number:
30:
Father’s Highest Educational Level:
32:
Have you changed jobs in the last 5 years?
noyes
Do you plan to?
noyes

Mother’s Information

34:
Mother’s Full Name:
36:
Mother’s Date of Birth:
38:
Mother’s SSN:
40:
Mother’s Occupation:
42:
Mother’s Employer:
35:
Number of years with employer:
37:
Work Phone Number:
39:
Mothher’s Highest Educational Level:
41:
Have you changed jobs in the last 5 years?
NoYes
Do you plan to?
NoYes

Family Information

43:
Parent’s Marital Status:*
Married/RemarriedSeparatedDivorcedWidowedNever Married

47:
Parent’s date of state residency:
48:
Number in College 2017-18 school year:
Enter the number of family members who will attend college at least half-time for one or more academic periods in the 2017-2018 school year.
49:
Number in Household:
50:
Pre-College children:
Number of pre-college children in household
44:
Do you own your home?
YesNo
45:
How would you describe your credit rating?
ExcellentGoodFairPoor
46:
Do you have a will?
YesNo

Date will was signed:

Optional— for college/scholarship eligibility only


51:
What is your family’s religious preference?
52:
What is the name of your family’s place of worship?
53:
What race/ethnicity does your family consider itself?

Section Five: 2017-2018 Parents Income Information

Please note: Estimates are perfectly acceptable. We always use estimates to complete the financial aid forms so that the student is first in line pertaining to financial aid. You can use last year’s figures as a reference.

54:
Father’s Earned Income: Box 5, W-2

2017

2018

55:
Mother’s Earned Income: Box 5, W-2

2017

2018

56:
Parent’s Other Taxable Income: Business, Self-Employment, or Schedule C

2017

2018

57:
IRA Contributions:

2017

2018

58:
Contributions to Retirement Accts.: 401(k), 403(b), etc.

2017

2018

59:
Untaxed Social Security Benefits:

2017

2018

60:
Parent’s Adjusted Gross Income:

2017

2018

61:
Itemized deductions: IRS Form 1040 – Line 40

2017

2018

62:
Other Untaxed Income: (Specify)

2017

2018

63:
Total income tax: IRS Form 1040 – Line 63

2017

2018

64:
Elementary/Secondary School Tuition

For student

a: Parent’s contribution:

2017

2018

b: Tuition scholarships/grants:

2017

2018

All other siblings-

c: Parent contribution:

2017

2017

d: Tuition scholarships/grants:

2018

2017

65:
Un-reimbursed Medical/Dental Expenses:

DO NOT include health ins premiums!

2017

2017

66: Child Support Paid:

2018

2017

67:
Child Support Received:

2017

2018

68:
Worker’s Compensation:

2017

2018

69:
Unemployment Benefits:

2017

2018

70: Housing Allowance:

2017 DO NOT include health ins premiums!

2018

Asset Information Summary

List Retirement Account information in the identified section below**

Please include UTMA/UGMA (custodial accounts) as student assets

Parent(s)
Student
Sibling(s)
Value
Value
Value
71: Cash, Checking, Savings: *
72: Certificates of Deposit:
73: Treasury Bills:
74: Money Market Funds:
75: Mutual Funds: *
76: Stocks: *
77: Bonds:
78: Tax Exempt Bonds:
79: Annuities (non-qualified):
80: Trust Funds:
81: Limited Partnerships:
82: Business Assets:
83: Farm Assets:
84a. Do you live on farm? YNN/A84b. Did you file IRS Schedule F? YNN/A
85: Pre-paid Tuition Accts. (529’s) *:
86: Other Assets:

Section Six: Debt/Liability Obligations

ASSETS: HOME

87: Purchase Price: *

Purchase Year: *

Current Market Value: *

*If you own additional real estate, please list on separate sheets.

Liabilities (Debt)

Type
Monthly Payment *
Current Balance *
1st Mortgage (Principal/Interest Only): *
2nd Mortgage *
Home Equity/Line of Credit: *
Car Loans: *
Credit Cards: *
Other Debt: *
Group Life Insurance: *

Section Seven: Retirement Asset Information

Enter net asset value (asset value – asset debt)

RETIREMENT ACCOUNT(S) SUMMARY

TOTAL VALUE
Father
Mother
IRA: *
401(k): *
403(b): *
Pension Fund: *
Annuities (qualified): *
Rollover: *
Keogh/SEP/Simple: *
Monthly Contribution: *
($ or % amt.) *
Employer Match: *
($ or % amt.) *

Would you like to see an income estimate for your current personal retirement funds and contributions?

i. YesNo

ii. At what age do you anticipate retiring?

iii. What percent of growth do you anticipate on your retirement funds?

3%4%5%6%N/A

Section Eight: Family Members

Family Member Listing – Give information for all family members. Always include parents.

Full Name of Family member
Date of Birth
Name of School or College
Public / Private
Claimed by parent(s) as tax exemption for 2017?
Year in school
PrivatePublic
YesNo
PrivatePublic
YesNo
PrivatePublic
YesNo
PrivatePublic
YesNo
PrivatePublic
YesNo

Section Nine: Life Insurance

Do you have life insurance? *YesNo

Use separate sheet for addl. policies
Father
Mother
Individual Insurance Policy
#1
#2
#1
#2
Smoker or Nonsmoker:
Yes
No
Yes
No
Type of policy:
Term / Whole Life / Variable / VUL
Face Amount of Insurance Coverage:
Annual premium:
Cash Value:
Current surrender value:

Do you have term life insurance through an employer’s group policy? If so, note which parent(s) are covered, the amount of coverage, and the cost (if any):

In the event of death or disability, what expenses would you prefer to have paid? For example, enter an X under the husband’s column for the expense that should be covered in the event of the husband’s death.

Expense
Husband
Wife
Children(s) Education:
Home Mortgage:
Replaced income or Disability:
Day care:
Credit Card debt:
Automobile Loans:
Other:


Comments or Special Circumstances

List any items that would change or create an incorrect financial snapshot from the information provided on this form (e.g., a change of or loss of employment).

Section Ten: Login Account Creation

These credentials are required for filing financial aid forms

Credentials for COLLEGE BOARD
User Name:
Password:
Parents Credentials for FAFSA/FSAID:
User Name:
Password:
Student Credentials for FAFSA/FSAID:
User Name:
Password:

More about FAFSA