School Year
 
Step One: Student Information
Last Name:
First Name:
State of legal residence: 
Date of Birth: (MM/DD/YYYY)
What is your marital status as of today:    I am single, divorced or widowed. 
   I am married/remarried. 
   I am separated. 
Will you have your first bachelor's degree before July 1, ? Yes  No
   
Step Two: Student Income and Asset Information (to be completed by ALL students)
Additional instructions are available by selecting the .
     
  In or did you (or your spouse) or anyone in your household receive benefits from any of the federal benefit programs listed? Mark all that apply.  
     SSI   Food Stamps   Free or Reduced Price Lunch   TANF   WIC  
  As of today, are you (or your spouse) a dislocated worker? Yes  No
Use estimated or completed income tax returns.
  Will you file a tax return? Yes   No
  Are you eligible to file a 1040A, 1040EZ? Yes   No  
  Adjusted Gross Income?  
  U.S. Income Tax: (amount from IRS tables, based on taxable income).
  Number of Exemptions: (if claimed by parents, put 0).
  Student and spouse's income earned from work:
(W2 forms or IRS Form 1040 line 7 + 12 + 18 + Box 14 of Schedule K1 from 1065) 		 
  Student:
  Spouse:
  Additional Financial Information: (i.e. child support paid, Work-Study earnings, Hope and Lifetime Learning Tax Credits, Combat pay included in AGI)
  Untaxed Income (i.e. child support received, 401(k) and untaxed IRA contributions)
  Current balance of cash, savings, and checking accounts:
  Current net worth of investments: (exclude your home and retirement plans)
  Current worth of business/farm: (exclude a business you own and control and a farm that you live on and operate)
 
Step Three: Student Status
 
  Were you born before January 1, ? Yes   No
  As of today, are you married?  (Answer "Yes" if you are separated)? Yes   No
  Will you be working on a master's or doctorate program in -? Yes   No
  Are you currently serving on active duty in the U.S. Armed Forces for purposes other than training? Yes   No
  Are you a veteran of the U.S. Armed Forces? Yes   No
  Do you have children who receive more than half of their support from you? Yes   No
  Do you have dependents (other than your children or spouse) who live with you and who receive more than half of their support from you, now and through June 30, ? Yes   No
  Were you an orphan, ward of court, or in foster care at any time since you were 13 years old? Yes   No
  Are you in legal guardianship or determined to be an emancipated minor? Yes   No
  Since July 1, , were you officially determined to be an unacccompanied youth who was homeless or in danger of becoming homeless? Yes   No