* Please fill in all blanks. If the item does not apply, please fill in the blank with: O or N/A (not applicable).
GEORGIA MILITARY COLLEGE PREP SCHOOL
FINANCIAL AID APPLICATION FOR 2012-2013
Completed Financial Aid Applications and supporting documentation for ALL students must be received in the
GMC Prep School Office (201Usery Hall) not later than March 8, 2012.

All current students who wish to be a recipient of the Financial Aid Scholarship must apply/reapply for this scholarship each year.
(PLEASE PRINT)
STUDENT INFORMATION:
Name: ______________________________
(First)
________________________________
(Middle)
Social Security Number:_____________________________
______________________________
(Last)
Date of Birth:_______________
Grade for 2012-13:________
Mailing Address: ___________________________________________________________________
___________________________________________________________________
PARENT(S)/LEGAL GUARDIAN’S INFORMATION:
Parent(s)/Legal Guardian’s Names ________________________________________
Current Marital Status:
_____Single
_____Married
_____________________________________
_____Separated _____Divorced _____Widowed
Age of Oldest Parent/Guardian ______
Home Telephone Number: ______________________ Cell Number(s): ______________________
Work Telephone Number(s) ____________________________
______________________
____________________________
Parent/Guardian’s Email Address ________________________________________
_____________________________________
FINANCIAL/INCOME INFORMATION:
You must submit a copy of your signed 2011 U.S. Tax Return &W-2’s, and/or a statement of any untaxed income and/or
benefits reported with this application. ***Your application is incomplete without this supporting documentation***
Please provide information regarding your 2011 income, earnings, and benefits.
1.
2.
The following income figures are from:
________
A completed 2011 IRS Form 1040A, 1040EZ, or 1040TEL
________
A completed 2011 IRS Form 1040
________
We will not file a 2011 U.S. income tax return and will provide a statement for untaxed income and/or benefits
reported with this application including Child Support. (Skip to Question #4)
FOR SCHOOL USE ONLY
*****************************
2011 Adjusted Gross Income: $_____________
(Form 1040 – line 37, 1040A – line 21, 1040EZ – line 4)
3. 2011 U.S. Income Tax paid: $____________
(Form 1040 – line 55, Form 1040A – line 35, 1040EZ – line 10)
4. 2011 Income earned from work (father/step-father): $____________
(Form W-2 or 1099)
5. 2011 Income earned from work (mother/step-mother): $____________
(Form W-2 or 1099)
DATE REC’D IN
PRINCIPAL’S OFFICE _____________
REC’D BY
________
O Current Student
O Prospective Student
O Taxes
O Statement/Benefits
O W-2’s
O No W-2’s Self-employed
Date Scanned
_______________________________________________
Routed
___________________________________
By
_________________________________
M/NM
_ _______________________________
6. Untaxed income received in 2011(include amounts even for children not attending GMC):
$____________ Payments to tax-deferred pension and savings plans
$____________ Child support received
$____________ IRA deductions and payments to self-employed SEP, SIMPLE and Keogh
$____________ Tax exempt interest income
$____________ Untaxed portions of IRA distributions
$____________ Untaxed portions of pensions
$____________ Housing, food and other living allowances paid to members of the military, clergy & others
$____________ Veterans non-education benefits
$____________ Other untaxed income not reported, such as worker’s compensation or disability.
$___________ Grand Total Untaxed Income
7. Additional financial information from 2011:
$____________ Hope & Lifetime Learning tax credits
$____________ Child Support paid
$____________ Taxable earnings from work-study, assistantships or fellowships
$____________ Grant and scholarship aid reported to the IRS
$____________ Combat pay or special combat pay
$____________ Cooperative education program earnings
$___________ Grand Total Additional Financial Info
ASSET INFORMATION
8. As of today, what is the total current balance of cash, savings, and checking accounts? $____________
9. As of today, what is the net worth of your investments, including real estate? $:____________
(Do not include home)
10. As of today, what is the net worth of current businesses and/or investment farms? $_____________
Household Information
List all family members who are currently residing in the household. List the name and relationship to parent for each family
member. This list should include the student, parent(s), step-parent(s), and other family members who receive more than half
of their support from parents. Indicate any children who are attending either the GMC Prep School (this includes
prospective/new students) or college at least half time for the 2012-2013 academic year.
NAME
RELATIONSHIP
SCHOOL
________________________________________
____________________________
Attends: O GMC Prep
O GMC COLLEGE
________________________________________
____________________________
Attends: O GMC Prep
O GMC COLLEGE
________________________________________
____________________________
Attends: O GMC Prep
O GMC COLLEGE
________________________________________
____________________________
Attends: O GMC Prep
O GMC COLLEGE
________________________________________
____________________________
Attends: O GMC Prep
O GMC COLLEGE
________________________________________
____________________________
Attends: O GMC Prep
O GMC COLLEGE
In 2011, did you (or your spouse) receive benefits from any of the federal benefit programs listed below? _______ If yes,
please check the appropriate box.
Supplemental Security Income (SSI)
Food Stamps
Free or Reduced Price School Lunch
Temporary Assistance for Needy Families (TANF)
Special Supplemental Nutrition Program for Women, Infants and Children (WIC)
If your 2011 expected income will change significantly from your 2011 reported income, please use the area below to explain
the reason for any change. You will be required to provide supporting documentation to verify your explanation. After
initial review of your application, you will be notified regarding what specific documents will be required.
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
CERTIFICATION:
All of the information provided on this form by me or any other person is true and complete to the best of my knowledge.
I understand that this application is being filed jointly by all signatories.
I agree to provide a copy of my signed 2011 Federal Tax Return, W-2’s and/or a statement of any untaxed income
and/or benefits reported. I understand that my application is incomplete without this supporting documentation.
Parent/Guardian:____________________________________________
Signature
Date Completed:_______________________