Student's Name(s): Cum. GPA:

Parent #1/Dad’s Name:

Parent #2/Mom’s Name:

Student Age: Mother’s Age: Father’s Age:

# to be in College: Academic Year: # of siblings:

Estimated STUDENT’s Income for Calendar Year “preceding” High School graduation

W2/Earned Income $ Interest/Dividend Income $

Social Security Income (if any) $

Estimated PARENT’s Income for Calendar Year “preceding” High School graduation

Parent 1/Dad (W2 or net business income) $

Parent 2/Mom (W2 or net business income) $

Total of All Other Taxable Income(s) on first page of IRS Tax Form 1040 $

Adjusted Gross Income (AGI: Form 1040 – bottom line of Page 1) $

Contributions to all Retirement Accounts for both parents
(If 401k, see W2 Box 12) $

Total Untaxed Income (soc. security, child support, etc) $

Monthly Mortgage $ # of Family Members in Household

Fed. Income Tax Paid $

Amt. Saving for College Now $ /Yr.

Max Amt. able to contribute for college $ /Yr.

Student's Assets

Checking & Savings Total $ CDs $ Stocks $

Bonds (EE, I or bond funds) $ Mutual funds (UGMA/UTMA) $

Total Assets in Siblings’ Names $ Trust or Conservator Acct $

Top Colleges Interested at this time for Student

1) 2)

3) 4)

Parents' Assets

Checking & Savings Total $ CDs $ Stocks $

Mutuals/Bond/529 Funds $ IRAs $ 401(k) $

Home Value $ Mortgage(s) $

Rental/Invest. Property EQUITY $ Business Value $

Business Type (S-corp, LLC, etc.)

Life Insurance Face Amount $ Cash Values $

Car Loan Debt $ Credit card debt $

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