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.

DEPENDENT STUDENT AND FAMILY INFORMATION

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):
 

2012 INCOME/ASSET INFORMATION STUDENT PARENT
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 Federal Income Tax (actual tax, not amount withdrawn from check - see key below) $ $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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1-800-846-1543
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