2014 - 2015 Financial Assistance Worksheet
  • Please use 2012 actual or estimated data based upon your parents' and your 2012 income tax returns to complete this worksheet
  • This is only an estimate. Your actual eligibility for financial aid will be based upon the completion of a Free Application for Federal Student Aid (FAFSA), which is available online at www.fafsa.ed.gov, from your local high school, or from Southwestern College after January 1, 2014.
  • If the parent you live with is remarried, please note that whenever this form says "parents," we also mean your stepparent.
  • Feel free to call or email Stephannie DeLong, Family Financial Planner at stephannie.delong@sckans.edu, 800-846-1543 ext. 6241, or 620-229-6241 if you have questions as you complete this form.
  • This form is secured via an encrypted SSL Certificate.  All information will be kept confidential.


1. Full Legal Name and Date of Birth

Last Name:
First Name:
Middle Initial:
Date of Birth (MM/DD/YYYY):
Activity Interest:
Academic Interest:

2. Telephone Number:
Email Address:

3a. Parents' Marital Status *(If you live with a parent and step-parent, select "Married"):
Married    Single    Divorced    Separated    Widowed

3b. Birthday of Older Parent (MM/DD/YYYY):

4a. Number of people in household for 2014-15 (Include parents and all dependents):

4b. Number of family members in college for 2014-15 (excluding parents):

5. What type of tax return was filed? 1040 1040A
1040EZ 1040Tel
Not planning to file
1040 1040A
1040EZ 1040Tel
Not planning to file
6. Adjusted Gross Income (see key below) $ $
7. Federal Income Tax (actual tax, not amount withdrawn from check - see key below) $ $
8. Number of Exemptions Claimed $ $
9. Earned Income Credit $ $
10. Earnings from Working $ Father $
Mother $
11. Other Income/Credit
a. Child support received, workers compensation, clergy housing allowances, payments to tax-deferred pension or savings plans as reported in box 12 of your W-2 $ $
b. Child support paid, education tax credit, student grants reported on income tax as part of the adjusted gross income, federal work study earnings, military combat pay $ $
12. Current net worth of investments (stocks, bonds, CDs, money market funds, real estate - excluding the home in which you live) $ $
13. Current net worth of business/investment farm (do not include the farm your parents live on and operate) $ $
14. Cash, checking and savings $ $




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