A. Student Applicant Information
1. Name: ______________________________________ Date of Birth: __________________
Social Security # ______________________________ Sex:
Male Female
2. Indicate relationship of the parent/guardian listed in #4 to this student
(check all that apply):
Father Mother Stepfather Stepmother Male guardian Female guardian
3. Student lives with (check all that apply):
Father Mother Stepfather Stepmother Male guardian Female guardian
B. Parent or Guardian Information
4. Home address: _____________________________________________________________
5. Mother’s name: _________________________________________ _Age: ______________
Occupation: _______________________________ Title: ___________________________
Employed by: ____________________________ Years with firm:____
Full-time
Part-time
6. Father’s name: _________________________________________ Age: _______________
Occupation: _______________________________ Title: __________________________
Employed by: ____________________________ Years with firm:____
Full-time
Part-time
C. Parent’s Income and Expense Information
7. The information on this form is from a 2007 tax return that is:
Completed
Estimated
8. How many federal income tax exemptions did you or will you claim for 2007?
_____________
9. How many children, including student applicant, are residing in your home
and/or are receiving
support from you in 2008? ____________
10. How many children will be attending full-time childcare, tuition-charging
preschools, schools,
or colleges in 2008-2009? # of children: ________ $_____________
| 2007 | Estimated 2008 | |
| 11. Salaries and wages for parents, stepparent or guardian | ____________ | ____________ |
| 12. Taxable dividends and/or interest income form 1099(s) | ____________ | ____________ |
| 13. Alimony received or estimated (do not include child support) | ____________ | ____________ |
| 14. Net profit/loss from business and/or farm | ____________ | ____________ |
| 15. Other taxable income | ____________ | ____________ |
| 16. Untaxed portion of payments to IRA | ____________ | ____________ |
| 17. Keogh plan payments and self-employed SEP deduction | ____________ | ____________ |
| 18. Other IRS allowable adjustments to taxable income | ____________ | ____________ |
| 19. Child support received for all children | ____________ | ____________ |
| 20. Social security benefits for entire family | ____________ | ____________ |
| 21. Other non-taxable income | ____________ | ____________ |
| 22. IRS total itemized deductions from IRS schedule A | ____________ | ____________ |
| 23. Total federal tax (2007 IRS 1040 or 1040A) | ____________ | ____________ |
| 24. Self-employment tax paid | ____________ | ____________ |
| 25. Total paid for medical/dental insurance plans | ____________ | ____________ |
| 26. Total paid for medical/dental expenses not reimbursed by insurance | ____________ | ____________ |
| 27. Unusual expenses | ____________ | ____________ |
D. Family Assets and Debts
28. Home: Year Purchased: ________ Present market value: ___________
Annual payments on 1st mortgage: _________Annual payments on 2nd mortgage/equity
loan(s) _________
29. All other real estate: Present market value: _____________ Annual payments:
___________
30. Bank accounts – total of parent’s checking and savings accounts:
_____________________
31. Investments – net value (stocks, bonds, mutual funds): __________________________
32. Debts: _____________________
33. Amount to be paid in 2008: _____________________
34. Consumer debts: _____________________
35. Student assets: _____________________
Supplemental Information
36. How much of the Arbor tuition can you afford for 2008-2009: $___________________
37. Indicate the amount of tuition assistance you are requesting: $___________________
38. Provide information below for all dependent children. Enter first and last
names.
| A. Full Name | B. Name of present childcare, preschool or school (2007-2008) |
C. Grade or year in school | D. Age | E. Cost of childcare, preschool | Amount of this cost paid by | |||||
F. |
G. Financial aid or award |
H. Loan |
I. Students assets & earnings |
J. Friends, relatives, trust funds |
K. Other sources |
|||||
| $______ | $______ | $______ | $______ | $______ | $______ | $______ | ||||
| $______ | $______ | $______ | $______ | $______ | $______ | $______ | ||||
| $______ | $______ | $______ | $______ | $______ | $______ | $______ | ||||
| $______ | $______ | $______ | $______ | $______ | $______ | $______ | ||||
| $______ | $______ | $______ | $______ | $______ | $______ | $______ | ||||
39. If you do not own your home and rent your family resident, provide total
of annual rent you paid for 2007 and what you estimate for 2008: ____________
40. Total employment-related childcare expenses in 2007: ____________
41. Complete this item only if student applicants’ parents are separated,
divorced, or have never been married.
Divorced
Separated, not court action
Legally separated
Never married
Date of divorce or separation: ________________
Non-custodial parent’s full name: _______________________________________________
Home address:___________________________ Telephone: ________________________
Occupation: _____________________________Employed by: _______________________
Name of parent who claimed student as a tax exemption: ___________________________
Is there an agreement specifying a contribution for this student’s educational
expenses? ___
If yes, how much per year? $______________
PLEASE INCLUDE A COPY OF YOUR 2007 TAX RETURN WITH THIS APPLICATION.
Parent’s Certification and Authorization
We declare that the information reported on this form, to the best of our knowledge
and belief, is true, correct, and complete.
_____________________________________ __________
___________________ ____________________________
Signature ________________________________________Work
telephone ________________Home telephone
_______________________________________________ ______________________________ __________________
Signature ________________________________________Work
telephone _________________Home telephone
This information will be treated confidentially and will be carefully reviewed by Arbor Trustees, who are not Arbor parents, but who are on the financial aid committee. The committee will set the tuition in consultation with the Director.
For Arbor use only:
Amount of tuition assistance parents requesting: $____________________
Amount approved by the committee: $____________________
Initials of committee members: Date: __________________
___________________ _________ ___________________ ____________________