Parents Financial Statement

Parents Financial Statement To Apply For Aid in Academic Year 2011 2012 Four Steps to Completing Your Parents Financial Statement Completing the Parents Financial Statement (PFS) fully and accurately is a key part of your financial aid application. Please follow these tips below. 1. Gather materials you ll need to refer to as you complete the Parents Financial Statement. Gather your PFS Instruction Booklet and your W2 and 1040 tax forms. 2. Complete the PFS fully. Here are a few key tips: Parent and applicant names: Enter names exactly as they appear on tax returns and other official documents. Include your e-mail address and phone number in Section A so we can reach you if necessary. Fill in the school selections completely in Section B. Failure to list the complete school code, name, and state will result in delays. Looking for the SSS code for a school? See the Instruction Booklet or go to sss.nais.org/go/ssscode. Why complete your PFS online? It's the fastest, most accurate way to deliver your information to schools. And it'll save you 12. Apply online at sss.nais.org. If you entered answers for any items marked with a note icon ( ), provide explanation in Section F: Notes. Many schools require this explanation in order to make their financial aid decisions. 3. Sign your PFS and provide nonrefundable payment. If a school has given you a Fee Waiver Code, enter that 8-character code in the Payment section. If you pay by check, write Parent A s first and last name on the check. 4. Mail your PFS to School and Student Services. Using the PFS envelope in the Instruction Booklet, mail the PFS to: School and Student Services PO Box 449 Randolph, MA 02368-0449 For overnight mail, use this address: School and Student Services, 437 Turnpike Street, Canton, MA 02021. Don t forget the deadlines! Mail items at least 10 days before the school deadline to leave time for mail delivery and for processing time. Have you been instructed by schools to send additional required documents to SSS? Many schools require that you submit documents in addition to your Parents Financial Statement (such as your W-2 and/or 1040 tax return forms). If the school(s) to which you are applying has instructed you to send additional documents to SSS, you may send them either with the PFS or separately, using one of the envelopes provided in the Instruction Booklet. Enclose a Required Documents Cover Sheet (on the back side of this page) so that we can identify and process your documents. Indicate on the cover sheet which documents you are enclosing. Go online to sss.nais.org! View your Family Report and see whether the documents you mailed have been received and processed. If you have additional questions contact the SSS Customer Service Center at: (800) 344-8328 or sss@nais.org School & Student Services By NAIS PO Box 449 Randolph, MA 02368-0449

2011 2012 Required Documents Cover Sheet Helpline: 800-344-8328 : sss@nais.org PO Box 449, Randolph, MA 02368-0449 Required Documents Cover Sheet If the school(s) to which you are applying has instructed you to send additional documents to SSS, you may send them either with the PFS or separately, using one of the envelopes provided in the Instruction Booklet. 1. Fill out this cover sheet. 2. Gather one copy (not an original) of each document you have been instructed to send to SSS. Do not use paperclips or staple the documents. For documents smaller than 8 ½ x 11 (e.g., some W2s), copy these documents onto a full size sheet of paper, or tape each one to a full size sheet of paper. 3. In the top margin of each document, write the telephone number you used on the PFS. If any document does not have the name of Parent A, Parent B, or one of the student applicants, write Parent A s name at the top of the document. 4. Enclose this cover sheet and the documents in one of the envelopes provided in the Instruction Booklet. 5. Mail the envelope at least 10 days before your school s deadline to allow for mail delivery and processing time. Mail to: School and Student Services PO Box 449 Randolph, MA 02368-0449 For overnight mail, use this address: School and Student Services, 437 Turnpike Street, Canton, MA 02021. Your PFS Identification Number: If you submitted your PFS at an earlier date and you provided an e-mail address, you should have received e-mail confirmation that included a PFS ID number. It s okay to leave this line blank if you do not know your PFS ID number. Your Household Information Parent/Guardian A First Name Complete this section fully so we may match your documents to your application. Enter name exactly as it appears on tax/official forms. Last Name Code Date of Birth mmddyy Phone Parent/Guardian B First Name Last Name Code Your Enclosed Documents Date of Birth mmddyy Phone Indicate which documents you are enclosing. Enclose the documents you have been instructed by schools to send to SSS. Parents Financial Statement 2009 1040, 1040A or 1040EZ 2010 1040, 1040A or 1040EZ 2009 W2 Form 2010 W2 Form Schedule C 1099 Form SSS Business/Farm Statement (This is an SSS form.) Other Form If you have additional questions contact the SSS Customer Service Center at: (800) 344-8328 or sss@nais.org School & Student Services By NAIS PO Box 449 Randolph, MA 02368-0449

A Parent/Guardian A Parents Financial Statement 2011 2012 To Apply For Aid in Academic Year Helpline: 800-344-8328 : sss@nais.org Household Information 1 First name* MI Phone Employer Occupation Enter names exactly as they appear on tax/official forms. Questions marked with an asterisk (*) are CRITICAL Your PFS cannot be accepted without these filled in. Questions marked with a note ( ) require explanation in Section F: Notes. Last name* Home Work Cell Date of Birth* mmddyy PO Box 449, Randolph, MA 02368-0449 Enter suffix at end of last name, leaving one blank space. Parent/Guardian A will be our primary contact for correspondence. Please provide phone and email address should we need to contact you. SSS is not responsible for any communication delays caused by the absence of a contact number or email address. Years with employer If Parent/Guardian has more than one job, explain in Section F: Notes. Parent/Guardian B 1 First name* MI same as Parent/Guardian A Employer Date of Birth* mmddyy Years with employer Phone Home Work Cell Please provide phone and email address should we need to contact you. Occupation Last name* Enter suffix at end of last name, leaving one blank space. If Parent/Guardian has more than one job, explain in Section F: Notes. 2 If the applicant(s) has another living biological parent not listed in Question 1, indicate the relationship between the parents. Never Divorced Separated, no court action Legally separated married Is there a joint custody agreement? Yes No Year of divorce/separation Other parent s first name Last name MI Student Applicant Information Code Complete this section for each child applying to an SSS subscriber school(s). See SSS code list in the Instruction Booklet. For more than 3 schools, complete the Additional School Request form in the Instruction Booklet or at sss.nais.org/go/additionalschoolrequest. Applicant A 3 First name* MI Last name* Date of birth* mmddyy Grade applicant will enter in Sept. 2011 4 Applicant lives with: (select one) Parent/Guardian A and B Parent/Guardian A Parent/Guardian B Other 5 SSS School(s) applicant is applying to: (Enter full school name do not abbreviate.)* State* Applicant B Applicant C 3 First name* MI Last name* Date of birth* mmddyy Grade applicant will enter in Sept. 2011 4 Applicant lives with: (select one) Parent/Guardian A and B Parent/Guardian A Parent/Guardian B Other Date of birth* mmddyy Grade applicant will enter in Sept. 2011 4 Applicant lives with: (select one) Parent/Guardian A and B Parent/Guardian A Parent/Guardian B Other 5 SSS 3 First name* MI Last name* 5 SSS School(s) applicant is applying to: (Enter full school name do not abbreviate.)* School(s) applicant is applying to: (Enter full school name do not abbreviate.)* State* State*

C Family Income 6 Basic Tax Information 6A Have you completed your 2010 Tax Return? Yes No Note: It is not a requirement that you have completed your 2010 tax return to complete this PFS. 6B Income tax filing status for 2010: 1. Single 2. Married, joint return 3. Married, filing separately 4. Head of household 5. Do not file 6C How many federal income tax exemptions did you or will you claim for 2010?........................................................ 6D What did you or will you report as your total itemized deductions from IRS Schedule A?............................................... 6E Total Federal Tax Paid (IRS 1040 or 1040A).................................................................................... 7 Total Taxable Income 7A Salaries and wages for Parent/Guardian A (If you own a business or farm, include only any salary you pay yourself............... Report business/farm profit or loss in Question 7I.) 7B Salaries and wages for Parent/Guardian B (See note above.)....................................................... 7C Taxable dividends and/or interest income from 1099 statement(s)................................................. 7D Alimony received or estimated (Do not include child support.)...................................................... 7E Other taxable income (See guidance in Instruction Booklet.)......................................................... 7F Untaxed portion of payments to IRA........................................................................ 7G Keogh plan payments and self-employed SEP deduction........................................................ 7H Other IRS allowable adjustments to taxable income............................................................ Business and/or Farm Details Complete this section only if you own a business and/or farm. (See Instruction Booklet.) Schools to which you are applying may require that you also complete the SSS Business/Farm Statement. 7I Net profit/loss from business and/or farm (If loss, use parentheses around figures. Do not use a negative sign.)................... 7J Owner of the business and/or farm: (select only one) Parent/Guardian A and B Parent/Guardian A Parent/Guardian B 7K 7L Type of business and/or farm: Percentage of ownership % 7M Business/Farm Assets 7N Business/Farm Debts 7O Total depreciation claimed on business and/or rental property assets............................................... 7P Self-employment tax paid................................................................................. 8 Total Nontaxable Income 8A Child support received for all children....................................................................... 8B Social security benefits for entire family...................................................................... 8C Other nontaxable income (Complete the worksheet below.) Worksheet other nontaxable income breakdown/detail. Payment to tax-deferred pension and savings plans as reported on W-2 forms(s). Include amounts withheld from earnings for qualified retirement plans, such as 401(k)and 403(b) plans. Do not report amounts entered in 7F.................... Pretax contribution or employer-provided untaxed income from fringe benefit plans (cafeteria or 125 plans)............... Cash support, gifts, or money paid on your behalf (from relatives or non-relatives)..................................... Household expenses and any money paid by separated or divorced spouse in lieu. of child support...................... Housing, food and other living allowances (excluding rent for low-income housing) paid on your behalf or to you as a member of the military, clergy, or other occupation (including cash payments and cash value of benefits), or contributions to your household income provided by other non-dependent members................................................... Earned income credits, welfare benefits, veterans benefits, workers compensation................................... Income from tax-exempt investments....................................................................... Income earned abroad (Foreign Income Exclusion, IRS Form 2555, or 2555EZ)......................................... Other untaxed income and benefits not included above......................................................... Enter the 2010 and estimated 2011 totals. Totals 9 Applicant Income and Assets Enter information only for applicant(s) listed in Section B. 9A Student applicant earnings for 2010..................................................... Student applicant estimated earnings for 2011............................................. Applicant A Applicant B Applicant C 9B Did/will the student applicant file a federal tax return for 2010?............................... Yes No Yes No Yes No 9C Student applicant assets (See Instruction Booklet.)...........................................

D Family Assets and Debts Real Estate 10A Year purchased 10B Purchase price 10C Present market value 10D Unpaid principal 10E Annual payments 10 Home (if owned)................. 10F Do you have a second mortgage or home equity loan? Yes No 10G If so, describe the purpose of the second mortgage and/or equity loan in Section F: Notes. 10H Unpaid principal on 2nd mortgage/equity loan(s) 10I Annual payments on 2nd mortgage/equity loan(s)..... 10K Number of locations 10L Total purchase price 10M Present market value 10N Unpaid principal 10O Annual payments 10J All other real estate (See Instruction Booklet.) 11 If you rent your home, provide TOTAL amount you paid in rent for this whole year, and your estimate for next year..... 12 13 Vehicles Describe all vehicles you own. If you require more space, continue in Section F: Notes. Family cars owned or leased. 1. (make, model, year) Current debt Provided by employer/business Own Lease 2. (make, model, year) Provided by employer/business Own Lease 3. (make, model, year) Provided by employer/business Own Lease Boats or other recreational vehicles owned or leased (make, model, year). Own Lease Annual lease cost Other Assets/Debts 14 Bank accounts total of parents checking and savings (interest-bearing and noninterest bearing) accounts................................... 15 Investments net value (Include stocks, bonds, mutual funds, and value of whole life insurance policies. See Instruction Booklet.)....................... 16 Is there an employee retirement plan for: Parent/Guardian A? Yes No 16A Total value of Parents /Guardians IRAs,........ Parent/Guardian B? Yes No pensions, and other retirement plans 17 Debts (See acceptable debts in Instruction Booklet.) 17A Amount in 17 planned to be paid during 2011..... 18 E Consumer debts (Include total from credit card purchases NOT reported elsewhere in this PFS. See Instruction Booklet.)............................. Additional Family Information (Educational and Other Expenses) 19 How many children are/will be receiving support from you in 2011? 19A How many of them will attend tuition-charging childcare centers, schools, or colleges? 20 In the chart below, under Educational Expenses, enter the educational expenses you incurred and will incur for ALL your children both those applying for financial aid ( Applicant A, B, and C ) AND other dependent children. Then, under Payment Sources, enter the dollar amount you will use from each source to pay for these educational expenses. Continue in Section F: Notes if necessary. Educational Expenses Payment Sources Enter first and last name of each of your children below Name of childcare provider/school/college Grade in school/ year in college Cost Parent/ Guardian Loan Student s assets & earnings Friends/relatives/ trust funds/other Financial aid This is: Applicant A B C 2011-12 (if different from ) This is: Applicant A B C Another Dependent Child 2011-12 (if different from ) This is: Applicant A B C Another Dependent Child 2011-12 (if different from ) This is: Another Dependent Child 2011-12 (if different from ) This is: Another Dependent Child 2011-12 (if different from )

21 How much do you believe you can afford for educational expenses for the 2011-12 year for each child you support? Do not leave blank. Applicant A Applicant B Applicant C All Other Dependents TOTAL Other Expenses 22 Total medical/dental expenses not reimbursed by insurance companies............................................. 23 Total paid for medical/dental insurance plans................................................................. 24 Unusual expenses (See lists of acceptable expenses in the Instruction Booklet.)............................................ 25 26 Annual cost of clubs requiring dues over 250 in 2010.......................................................... Costs of camps and lessons in 2010.......................................................................... F 27 Costs of vacations in 2010................................................................................. Notes Use this space to provide further explanation for all noted ( ) items. Please follow the example below. It s extremely important to complete this section as schools may be unable to grant financial assistance without an explanation of noted ( ) items. Ques.No. 1. I have a second job working as a part-time waiter at ABC Restaurant. PARENTS CERTIFICATION, AUTHORIZATION, AND PAYMENT We declare that the information reported on this form, to the best of our knowledge and belief, is true, correct, and complete. We recognize that intentionally providing false or inaccurate data may impact our ability to receive any financial aid and/or our ability to maintain a contract with a school. We authorize transmittal of this form and the information within it to the schools and organizations named in section B and its use by School and Student Services By NAIS and its third party service providers. SSS, its third party service providers, and any of the schools and organizations designated by us in section B to receive copies of this information have our permission to verify the information reported, and we understand and agree that this verification may include the disclosure of personal and financial information, such as an official copy of our latest income tax return and/or a signed IRS Form 4506. We also understand and agree to the terms and conditions included in the Instructions Booklet accompanying this form and found on the SSS website. We agree that once submitted, this application cannot be withdrawn or deleted from the SSS system. If you do not agree to the above, or have not reviewed the terms and conditions, please do not submit your PFS. Make check or money order for 47 in U.S. Dollars payable to School and Student Services By NAIS. This fee is nonrefundable. If you received an Application Fee Waiver Code from a school/organization, please enter that 8-character code below. Payment My check or money order for 47 is enclosed My Application Fee Waiver Code is The PFS fee is nonrefundable. Enter the code exactly as it was given to you, as an incorrect code will result in delays. Parent/ Guardian A Parent/ Guardian B Signature Signature Date Date Copyright 2010 NAIS. School and Student Services By NAIS is a service of NAIS. All rights reserved. NAIS, the NAIS logo and SSS logo designs are registered trademarks of NAIS.