Parent Information Worksheet (PWKST)

Transcription

1 Parent Information Worksheet (PWKST) Use this Answer Form if you prefer to prepare your financial data on paper before entering it in the CSS Profile. If parents are separated or divorced, the main supporting parent (and stepparent, if applicable) should complete the Parent Information Form. The other parent (and stepparent, if applicable) should complete the Non-Custodial Parent Information Form. Please enter all dollar amounts in whole dollars only. Student Name: Student GUID: Student Date of Birth: Parents/Stepparents/Guardian Information Parent 1 is your main supporting parent or parent who most recently provided the greatest financial support (see Parent Information Worksheet Instructions for more details.) Parent 2 is the spouse of Parent 1, if applicable. Parent 2 is the spouse of Parent 1, or is the student s other legal parent if the parents are unmarried and both parents live together. If Parent 1 s Current Marital Status is Single, Separated, or Divorced, skip Parent 2 questions. Parent 1 Parent 2 Name: Date of Birth: / / / / Street: City: State: Zip Code: Territory/Country: Address: Current Marital Status of Parent 1: Year Parent 2/Stepparent/Guardian Died, if applicable: Occupation: Job Title: Employer: Number of Years with this Employer: Parent Information Worksheet (PWKST), Page 1 of 5

2 Parents Household Information Phone Number: ( ) Parents Address: Parent Last Claimed Student as Dependent: _ Parents Release of Financial Data (Yes, No): Number of Family Members Financially Supported by Parents: Number in College in : Number of Parents in College: Date of Divorce/Separation: Month Year Date of Remarriage: Month Year State of Legal Residence: Parents Living Abroad (Yes/No): Last Year Claimed: Federal Benefits Received in 2015 or 2016: Income from Non-U.S. Sources in 2016 (Yes/No): Parents Income and Expenses Schools may require one or both years of income and expense data (Estimated) Source of Following U.S. Tax Figures: Completed IRS Form 1040A or 1040EZ; Completed IRS Form 1040; Estimated IRS Form 1040A or 1040EZ; Estimated IRS Form 1040; Tax return will not be filed; Completed IRS Form 1040NR, Estimated IRS Form 1040NR Number of Exemptions: Adjusted Gross Income from IRS Form: $ $ Itemized Deductions (1040 Schedule A): $ $ U.S. Income Tax Paid: $ $ Parent 1 s Earned Income: $ $ Parent 2 s Earned Income: $ $ Interest Income: $ $ Dividend Income: $ $ Other Taxable Income: $ $ Earned Income Credit: $ $ Social Security Benefits: $ $ AFDC/TANF: $ $ Child Support Received: $ $ Other Untaxed Income/Benefits: $ $ Medical/Dental Expense: $ $ Elementary/Junior/High School Tuition: $ $ Number of Children's Tuition Paid: Child Support Paid: $ $ Education Credits Received: $ $ Taxable Income Exclusion: $ $ Parent Information Worksheet (PWKST), Page 2 of 5

3 Parents Assets Value Debt Cash, Savings, and Checking Accounts (Today): $ If Home is Owned, Home: $ $ If Home is Owned, Year Purchased: If Home is Owned, Home Purchase Price: $ Other Real Estate $ $ Investments $ $ Business: $ $ Small Family-Run Business (Yes, No): Farm: $ $ Family Lives on Farm (Yes, No): Retirement Accounts Value: Parents Household Expenses $ Home Monthly Rent/Mortgage $ State and Local Taxes 2016 $_ Own or Lease a Vehicle: (Own, Lease, Own and Lease, None): Vehicle 1. Model Year: Make: Model: Vehicle 2. Model Year: Make: Model: Total Vehicle Indebtedness: $ Total Monthly Vehicle Payments: $ Parents Household Members Parent 1 Information College Student (Yes, No): School/College/Institution: Class : Tuition and Fees for Household Members $_ Parent 2 Information College Student (Yes, No): School/College/Institution: Class : Tuition and Fees for $ Household Member 1 Household Member 2 Name: Age: Relationship to Student: College Student (Yes, No): School/College/Institution : Class : Assistance from Parents : $ $ School/College/Institution : Assistance from Parents Last Year in School: $ $ Parent Information Worksheet (PWKST), Page 3 of 5

4 Household Member 3 Household Member 4 Name: Age: Relationship to Student: College Student (Yes, No): School/College/Institution : Class : Assistance from Parents : $ $ School/College/Institution : Assistance from Parents Last Year in $ $ School: Household Member 5 Household Member 6 Name: Age: Relationship to Student: College Student (Yes, No): School/College/Institution : Class : Assistance from Parents : $ $ School/College/Institution : Assistance from Parents Last Year in $ $ School: Parent Information Worksheet (PWKST), Page 4 of 5

5 Parent s Special Circumstances Enter any special circumstance that you wish to be considered in the assessment of your application. If you do choose to add an explanation of your special circumstance, the financial aid administrator may take your explanation into consideration Parent Information Worksheet (PWKST), Page 5 of 5