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III. Parents'
Information
7. Father or Guardian:
Occupation:
Name of employer:
8. Mother
or Guardian:
Occupation:
Name of employer:
Other dependents
(include ages, relationships,
partial or full dependency):
9. A. Did
you live in your parent(s)' home for more than six weeks in the
past year?
Yes
No
B. Do your parents list you as a tax exemption
on their Federal Income Tax return?
Yes
No
C. Have you received $750 or more in
assistance from your parents in the past
year for clothes, medical care, insurance, etc.?
Yes
No
If you answered NO to all questions
(A, B and C), then you may claim yourself
financially independent and should submit
your own personal information in question 10 below.
If you answered
YES to one or more of the
questions above, you may not claim yourself
financially independent, and you must provide
your parent(s)' complete financial information.
10. Father
Current Year Estimated Gross Income ($):
Previous Year Gross Income ($):
Federal Income Tax paid previous year ($):
Estimated Total Net Worth ($):
Father's
signature and date:
________________________________________
Mother:
Current Year Estimated Gross Income ($):
Previous Year Gross Income ($):
Federal Income Tax paid previous year ($):
Estimated Total Net Worth ($):
Mother's
signature and date:
________________________________________
Student: (please complete
if independent from parents)
Current Year Estimated Gross Income ($):
Previous Year Gross Income ($):
Federal Income Tax paid previous year ($):
Estimated Total Net Worth ($):
Student's
signature and date:
________________________________________
C. Parent(s)'
Contribution to Cost of Program:
$ __________ |
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