2015 – 2016 Student Answer Form
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Use this Answer Form if you prefer to prepare your financial data on paper before entering it in the online
Need Access Application at www.needaccess.org. Do not mail or fax any paper forms to Access Group.
This Answer Form is designed to be used with the Student Information Worksheet Instructions. For questions
where the Instructions provide a list of possible answers, enter the applicable answer in this worksheet. For
example, for question 2k, which asks the student’s marital status, fill in the applicable choice, such as
Unmarried; Unmarried, but will be married by 6/1/2016; Separated; or Divorced/Widowed (do not fill in the
number shown).
Please enter all dollar amounts in whole dollars only.
Student Information
1a, 1b, 1c. Name: _________________________________
1d. Street Address: ___________________________
1 e. City ________________________________ 1f. State ____________________ 1g. Zip Code: _____________
1h. Territory/Country: ___________________________
1i. Area Code/Phone Number: (___) – ___________
1j. E-mail Address: _____________________________
1k. Social Security Number: ____________________
1m. Date of Birth: ________/______/_________
1n. State of Legal Residence: ___________________
Student’s Academic Plans and Household Information
2a. Degree Objective: _______________________
2b. Primary Care Objective (Yes, No): ____________
2c. Completion of Degree Requirements: ________
2f. U.S. Citizenship Status: ________________________
2fa. Alien Registration #/Visa Status: _____________
2h. Last Year Student Claimed by Parent: _______________
2k. Marital Status: ______________
2m. If Married, Marriage Date: (Month/Day/Year) ___________________
2n. Will spouse be a student during the 2015-2016 academic year? __________________
c26. Will student and spouse (or prospective spouse) maintain separate households during the summer of 2015?
(Yes, No) ______
2o. Will student and spouse (or prospective spouse) maintain separate households during the 2015-2016 academic
year? (Yes, No) ________
2q. Number of Student's Household Members in College in 2015-2016: ________
2r. Release of Financial Data to Parents: (Yes, No) ________
2t. Federal Benefits Received in 2014 or 2013: (Yes, No) ________
2z. Income from Non-U.S. Sources in 2014: (Yes, No) ________
Dependency Status Determination
2ds1. Veteran or Member of U.S. Armed Forces: (Yes, No) ____________________
2ds2. Dependents Other than a Spouse: (Yes, No) ____________________
2ds3. Orphan, Foster Care, Ward of Court: (Yes, No) ____________________
2ds4. Emancipated Minor or in Legal Guardianship: (Yes, No) ____________________
2ds5. Unaccompanied Homeless Youth: (Yes, No) ____________________
CST044. Housing Plans During 2015-2016 (Resident, With Parents, Off Campus): ____________________
2014-2015 Need Access Student Answer Form, Page 1 of 7
Student's (and Spouse's) Annual Income and Expenses
Schools may require one or both years of income and expense data.
3a, 4a. Source of Following U.S. Tax Figures:
2014
____________________
2015 (Estimated)
____________________
Completed IRS Form 1040A or 1040EZ; Completed IRS Form 1040; Estimated IRS Form 1040A or 1040EZ;
Estimated IRS Form 1040; Tax return will not be filed; Completed IRS Form 1040NR, Estimated IRS Form 1040NR
3b, 4b. Number of Exemptions:
____________________
____________________
3c, 4c. Adjusted Gross Income from IRS form:
$____________________
$____________________
3d, 4d. Itemized Deductions (1040 Schedule A):
$____________________
$____________________
3e, 4e. U.S. Income Tax Paid:
$____________________
$____________________
3f, 4f. Student's Income from Work:
$____________________
$____________________
3g, 4g. Spouse's Income from Work:
$____________________
$____________________
3h, 4h. Interest Income:
$____________________
$____________________
3i, 4i. Dividend Income:
$____________________
$____________________
3j, 4j. Other Taxable Income:
$____________________
$____________________
3k, 4k. Earned Income Credit:
$____________________
$____________________
3m, 4m. Social Security Benefits:
$____________________
$____________________
3n, 4n. AFDC/TANF:
$____________________
$____________________
3o, 4o. Child Support Received:
$____________________
$____________________
3p, 4p. Other Untaxed Income/Benefits:
$____________________
$____________________
3q, 4q. Medical/Dental Expense:
$____________________
$____________________
3r, 4r. Elementary/Junior/High School Tuition:
$____________________
$____________________
___________________
____________________
3t, 4t. Child Support Paid:
$____________________
$____________________
3u, 4u. Education Credits Received:
$____________________
$____________________
3v, 4v. Taxable Income Exclusion:
$____________________
$____________________
3s, 4s. Number of Children's Tuition Paid:
Student's (and Spouse's) Projected Income — 2015-2016
5a, 5b.Student's Income from Work:
Summer 2015
$____________________
Academic Year 2015-2016
$____________________
5c, 5d. Spouse's Income from Work:
$____________________
$____________________
5e, 5f. Other Taxable Income:
$____________________
$____________________
5g, 5h. Untaxed Income and Benefits:
$____________________
$____________________
Student's (and Spouse's) Projected Expenses — 2015-2016
5i, 5j. Child Care Expenses:
Summer 2015
$____________________
Academic Year 2015-2016
$____________________
5k. Unusual Expenses (Description):
_______________________________________________________
5m, 5n. Unusual Expenses (Amounts):
$____________________
5o. Current Rent/Mortgage:
$____________________
5p. State and Local Taxes – 2014:
$____________________
$____________________
2014-2015 Need Access Student Answer Form, Page 2 of 7
Student's (and Spouse's) Vehicle Information
9c. If Student/Spouse Owns/Leases a Vehicle: (Own, Lease, Own and Lease, None) ____________________
Vehicle 1. 9d. Year: _______ 9e. Make: ____________________
9f. Model: ____________________
Vehicle 2. 9g. Year: _______ 9h. Make: ____________________
9i. Model: ____________________
c54. Primary Motor Vehicle Purchase Price: $ __________________
Student's (and Spouse's) Summer Expenses
5q. Summer Expenses – 2014:
$____________________
5r. Summer Expenses – 2015:
$____________________
Student's (and Spouse's) Assets
Value
6a. Cash, Savings, and Checking Accounts (Today):
$____________________
6b, 6c. If Home is Owned, Home:
$____________________
6d. If Home Is Owned, Year Purchased:
Debt
$____________________
____________________
6e. If Home Is Owned, Home Purchase Price:
$____________________
6f, 6g. Other Real Estate:
$____________________
$____________________
6h, 6i. Business:
$____________________
$____________________
6ia. Small Family-Run Business (Yes, No):
6j, 6k. Farm:
____________________
$____________________
6m. Family Lives on Farm (Yes, No):
$____________________
____________________
6n, 6o. Stocks, Bonds, etc:
$____________________
6p. Contingent Trust Funds:
$____________________
6q. Vested Trust Funds:
$____________________
6r. Other Assets-Description:
$____________________
_________________________________________________
6s, 6t. Other Assets:
$____________________
6u. Retirement Accounts Value:
$____________________
6x. Cash, Savings, and Checking Accounts
$____________________
$____________________
Projected Balance as of September 1, 2015:
Student's Education Loans
7a. Federal Loans Owed as of June 1, 2015:
$____________________
7b. Private/Alternative Loans Owed as of June 1, 2015:
$____________________
7c. Other Education Loans Owed as of June 1, 2015:
$____________________
Spouse’s Education Loans (Total All Types)
7r. Total Owed as of June 1, 2015: $_______________
7s. Total to Be Repaid during the 2015-2016 Academic Year: $________________
2014-2015 Need Access Student Answer Form, Page 3 of 7
Student’s/Spouse’s Non-Education Debt
Owed as of 6/1/2015
To be Repaid in 2015-2016
8a, 8b. Credit Card Debt:
$____________________
$____________________
8c, 8d. Auto Loan Debt:
$____________________
$____________________
8e, 8f. Other Non-Education Debt:
$____________________
$____________________
Student Applicant's Prior Year Financial Aid
10h. School/College/Institution in 2014-2015:
$____________________
10i. Tuition, Fees, Room & Board in 2014-2015:
$____________________
10j. Scholarships or Gift Aid - 2014-2015:
$____________________
10k. Loans and Employment - 2014-2015:
$____________________
10m. Assistance from Parents - Last Year in School:
$____________________
Other Student Household Members
(11) Member 1
(12) Member 2
(13) Member 3
(14) Member 4
a. Name:
_________________
______________
______________
______________
b. Age:
_________________
______________
______________
______________
c. Relationship:
_________________
______________
______________
______________
(15) Member 5
(16) Member 6
(17) Member 7
(18) Member 8
a. Name:
_________________
______________
______________
______________
b. Age:
_________________
______________
______________
______________
c. Relationship:
_________________
______________
______________
______________
Student's Employment
Summer 2015
Academic Year 2015-2016
20i. Employer Name:
____________________
20n. ____________________
20j. Type of Work:
____________________
20o. ____________________
20k. Number of Weeks Employed:
____________________
20p. ____________________
20m. Weekly Earnings:
$____________________
20q. $____________________
Spouse’s or Prospective Spouse’s Employment
Summer 2015
Academic Year 2015-2016
21i. Employer Name:
____________________
21n. ____________________
21j. Type of Work:
____________________
21o. ____________________
21k. Number of Weeks Employed:
____________________
21p. ____________________
21m. Weekly Earnings:
$____________________
21q. $____________________
2014-2015 Need Access Student Answer Form, Page 4 of 7
Student’s Education History
22a. Number of Prior Undergraduate/Graduate Institutions Attended: ______________
22b. Undergraduate/Graduate Institution 1 Name: ____________________________________________________
22c. Dates of Attendance: _______________________
22d. Degree Awarded: __________________________________
22e. Institution 2 Name: _____________________________________________________
22f. Dates of Attendance: _______________________
22g. Degree Awarded: __________________________________
22h. Institution 3 Name: _____________________________________________________
22i. Dates of Attendance: _______________________
22j. Degree Awarded: __________________________________
22k. Institution 4 Name: _____________________________________________________
22m. Dates of Attendance: ______________________
22n. Degree Awarded: __________________________________
22o. Institution 5 Name: _____________________________________________________
22p. Dates of Attendance: ______________________
22q. Degree Awarded: __________________________________
22r. Institution 6 Name: _____________________________________________________
22s. Dates of Attendance: ______________________
22t. Degree Awarded: __________________________________
22u. Institution 7 Name: _____________________________________________________
22v. Dates of Attendance: ______________________
22w. Degree Awarded: __________________________________
22x. Institution 8 Name: _____________________________________________________
22y. Dates of Attendance: ______________________
22z. Degree Awarded: __________________________________
Previous Undergraduate Degree Financial Aid
Grants
23a, 23b. Undergraduate Studies:
$______________
Loans
$______________
Previous Graduate Degree Financial Aid
Grants
23c, 23d. Graduate Studies:
$______________
Loans
$______________
Student’s Current Degree Financial Aid
Grants
23e, 23f. Current Degree:
$_______________
Loans
$______________
Student in Default on Loans
23p. In Default on a Federal Loan (Yes, No): __________
23q. Explanation of Default (if any):
_________________________________
Spouse’s Education and Financial Aid History
24a, 24b. Spouse's First and Last Name: ________________________________________
24c. Spouse's Age: _______________________
If Spouse will be enrolled at least half time in 2015-2016:
24d. Type of Institution Attending (Undergraduate, Graduate/Professional): _______________________
2014-2015 Need Access Student Answer Form, Page 5 of 7
24e. Name of Institution Attending: _______________________
24f. State Location of Institution: _______________________
24g. Estimated Tuition for 2015-2016: $ _________________
24h. Year in School in 2015-2016 (First Year, Second Year, Third Year, Fourth Year, Fifth Year, Sixth Year, Seventh
Year or Later): _____________________
24i. Applied for Financial Aid for 2015-2016 (Yes, No): _______
24j. Status of Grants for 2015-2016 (None, Granted, Pending): __________
24k. Amount of Grants for 2015-2016: $ ______________
24m. Status of Loans 2015-2016 (None, Granted, Pending): ____________
24n. Amount of Loans for 2015-2016: $ ______________
24o. Last Degree Awarded to Spouse: _______________________
24p. Dates Attended for Last Degree: _______________________
24q. Major Field of Last Degree: __________________
Student’s (and Spouse’s) Other Resources
25a. Student's Other Scholarships/Grants for 2015-2016 Academic Year: $ _______________________
Financial Assistance from Parents
25b. Assistance from Student’s Parents for Academic Year 2014-2015: $ ____________________
25bt. Type of assistance (Gift, Loan): _______________________
25c. Assistance from Student’s Parents for Academic Year 2015-2016: $ ____________________
25ct. Type of assistance (Gift, Loan): _______________________
Other Financial Assistance
25d. Assistance for Academic Year 2014-2015: $ ______________
25dd. Source of Other Assistance: ___________________
25dt. Gift or Loan: _____________
25e. Assistance for Academic Year 2015-2016: $ ______________________
25ed. Source of Other Assistance: ___________________
25et. Gift or Loan: _____________
Prospective Spouse's Financial Information
26a. Income from Work, Summer 2015: $ _______________________
26b. Income from Work, Academic Year 2015-2016: $ _________________
26c. If Home Is Owned, Home Value: $ _______________________
26d. If Home Is Owned, Home Debt: $ _______________________
26e. If Home is Owned, Year Purchased: _______________________
26f. If Home is Owned, Home Purchase Price: $ _______________________
26g. Retirement Account Value: $ _______________________
26j. Cash, Savings, and Checking Accounts Projected Balance as of September 1, 2015: $ ___________________
2014-2015 Need Access Student Answer Form, Page 6 of 7
Student’s Special Circumstances
29. This section is not required of you to complete. Enter any special circumstance that you wish the school(s) to
consider in their assessment of this application. If you do choose to add an explanation of your special
circumstance, the financial aid administrator at the schools to which the application is being submitted may take
your explanation into consideration.
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2014-2015 Need Access Student Answer Form, Page 7 of 7