U.S. Financial Aid Estimate Worksheet
Student:
Address:
Parent(s):
Phone:
Email address:
Parents Projected 2010 Information
Adjusted Gross Income (1040A-line 21; 1040-line 37)
_______________________
Father's income from work (W-2)
_______________________
Mother's income from work (W-2)
_______________________
Untaxed income (housing allowance, payments paid directly or withheld
from earnings to tax-deferred pension and savings plans, Deductible IRA
and/or Keogh payments)
_______________________
Other income
_______________________
Federal taxes to be paid (1040A-line 35; 1040-line 55)
_______________________
Assets (cash, savings, checking, not to include value of retirement accounts)
_______________________
Other real estate/assets (value minus debt)
(not to include retirement accounts or your primary residence)
_______________________
Farm/Business (value minus debt)
_______________________
Age of older parent
_______________________
Family size (people you will support between July 1, 2011 and June 30, 2012) _______________________
Number in college in 2011-2012 (at least half time; excluding parents)
_______________________
Medical/Dental expenses (not covered by insurance)
_______________________
Elementary/Secondary Tuition to be paid in 2011-2012
_______________________
Student Projected 2010 Information
Total income
_______________________
Assets (cash, savings, checking, investments)
_______________________
Other Student Information
H.S. GPA ______ ACT Score ______ SAT Score ________ Class Rank _____ out of _____
Church Denomination___________________________________________________________
Return to: Office of Scholarships and Financial Aid 3201 Burton Street, S.E. Grand Rapids, MI 49546
616-526-6134 800-688-0122 Fax 616-526-6883