Student Aid Form â¢ 2010 - LycÃ©e FranÃ§ais de New York

More documents

Recommendations

Info

Form #003 (2009)AStudent Aid Form • 2010 – 2011PARENT, GUARDIAN or OTHER ADULT RESPONSIBLE FOR TUITION• IMPORTANT: Print clearly and neatly with a ball point pen •Check one: o Father o Mother o Stepfather o Stepmother o Other Adult Check one: o Father o Mother o Stepfather o Stepmother o Other AdultBPARENT, GUARDIAN or OTHER ADULT RESIDING WITH PARENT A_____________________________________________________________________________________________________________________________________________Last Name First Name MI____________________________________________________ __________ ( ____________ ) ___________________________________________________Social Security Number Age (Area Code) Home Phone_____________________________________________________________________________________________________________________________________________Address Apt. #_____________________________________________________________________________________________________________________________________________City State Zip( ________ ) _________________________________________________ __________________________________(Area Code) Work PhoneE-mail address_____________________________________________________________________________________________________________________________________________Last Name First Name MI____________________________________________________ _________ ( ____________ ) ___________________________________________________Social Security Number Age (Area Code) Home Phone_____________________________________________________________________________________________________________________________________________Address Apt. #_____________________________________________________________________________________________________________________________________________City State Zip( ________ )_________________________________________________ __________________________________(Area Code) Work PhoneE-mail address_________________________________________May PSAS contact you at work ifEmployed by How Long? there are questions? o Yes o Noo If you are self-employed, check this box and refer to Section K of this form.CDEPENDENTS(DO NOT LEAVE BLANK)_________________________________________May PSAS contact you at work ifEmployed by How Long? there are questions? o Yes o Noo If you are self-employed, check this box and refer to Section K of this form.Number of dependent children who will attend a tuition charging school: daycare, Pre-K, elementary school, secondary school, or college in the fall of 2010. __________Please list all dependent children in order of oldest to youngest, including college students. Indicate each dependent’s relationship to Parent/Guardian A: child, foster child, grandchild, etc.DependentLast NameDependentFirst NameMIAgeRelationshipto Parent/Guardian AName of school student plans to enter in thefall of 2010(PLEASE DO NOT ABBREVIATE)City/StateGradein thefall of2010Applyingfor Aid?(check one)YES NOAmount I/Wefeel I/We canpay towardtuitionTuitionchargedyearly perstudentOfficeUse Only12345o Please check if additional dependents are listed on a separate sheet.DHOUSEHOLD INFORMATION1. Number of individuals who will reside in my/our household during the 2010-2011 school year:School Name:City/State:School Name:City/State:School Name:City/State:School Name:City/State:School Name:City/State:2. Current marital status/housing arrangement of Parent/Guardian A:EForm #003 (2009)Parents/Guardians ___________ Children ___________ Other* ___________*If Other, please explain relationship to Parent _ ________________________DIVORCED, SEPARATED OR SINGLE PARENTS (TO BE COMPLETED BY PARENT OR GUARDIAN LISTED IN SECTION A)1. Date of separation (Month/Year) ____________________________________________________________________________________2. Date of divorce (Month/Year) _________________________________________________________________________________________3. Non-custodial parent _____________________________________________________________________________________________________Last Name First Name MI4. Do you receive or pay child support? o Receive $______________________ per yearo Pay $__________________________ per yearo Neithera. o Single, never Married* d. o Divorced* g. o Residing w/Significant Otherb. o Married e. o Remarried* h. o Other:______________c. o Widowed f. o Separated* ______________________5. Who claimed student as a tax dependent in 2009? ____________________________6. Who is responsible for the tuition for the dependent(s) listed in Section C?o Fathero Mother*If Divorced, Remarried, Separated or Single, please complete Section E.% Name ____________________________________________________% Name ____________________________________________________o Other % Name ____________________________________________________ **If tuition is shared, each responsible party must complete a Student Aid Form (SAF).
FTAXABLE INCOMEThe 2009 federal tax return for student’s household was:o Filedo Not filed yet (See Required Documentation section)o I/we do not file. I/we only receive non-taxable income1. Total number of exemptions claimedon Federal Income Tax form:2. Parent/Guardian A total taxableincome from W-2 wages.(List total income for Parent A only)3. Parent/Guardian B total taxableincome from W-2 wages.(List total income for Parent B only)Actual 2009 Estimate 2010$ ______________ $ _____________$ ______________ $ _____________4. Net business income* from self-employment,farm, rentals, and other businesses.(*Go to Section K)(Attach Schedule C, E, and/or F from your IRS 1040) $ ______________ $ _____________See 2009 1040 lines 12, 17 and 185. Other non-work taxable income from interest,dividends, alimony, unemployment, and nonbusinessincome.See 2009 1040 lines 8a, 9a-11, 13, 14, 15b, 16b, 19-21See 2009 1040A lines 8a-14b6 Allowable “Adjustments to Income” as reportedon your IRS 1040, 1040A or 1040EZ.See 2009 1040 line 36 or 1040A line 207. Total “Adjusted Gross Income” as reportedon your IRS 1040, 1040A or 1040EZ.See 2009 1040 line 37 or 1040A line 218. Total Tax Paid as reported on yourIRS 1040, 1040A or 1040EZ.See 2009 1040 line 60 or 1040A line 379. Medical/dental expenses as reported onSchedule A line 1 of your IRS 1040 Form.GNON-TAXABLE INCOME$ ______________ $ _____________$ ______________ $ _____________$ ______________ $ _____________$ ______________ $ _____________$ ______________ $ _____________List the total amount received from 1/1/09-12/31/09 for all recipients in household.DO NOT list monthly amounts.HIHOUSING INFORMATION (DO NOT LEAVE BLANK)20. Do you rent or own your residence? o Rent o Own (go to line 22)21. If renting, what is the monthly rental payment? $ _________________________________________________________a. Amount paid by household $ ______________________________________ per monthb. Amount paid by other source(s) $ ______________________________________ per month22. If you own your residence:a. What is the current market value? $ ______________________________________________b. What is the amount still owed,including home equity loans?ASSETS & INVESTMENTS (AS OF 12/31/09)23. Total amount in cash, checking, and savings accounts $ __________________________________24. Total value of money market funds, mutual funds,stocks, bonds, CDs, or other securities25. Total value of IRA, Keogh, 401K, SEP or otherretirement accounts26. If you own real estate other than your primary residence,$ ______________________________________________c. What is the monthly mortgage payment? $ ______________________________________ per month$ __________________________________$ __________________________________a. What is the fair market value? $ _______________b. What is the amount still owed? $ __________________________________27. Do you own a business? o Yes o NoIf Yes, please go to Section K.a. What is the fair market value of your business? $ __________________________________b. What is the amount still owed? $ __________________________________28. Do you own a farm? o Yes o NoIf Yes, please go to Section K.a. What is the fair market value of your farm? $ __________________________________10. Child support $ ______________________________ per year11. Cash Assistance (TANF) $ ______________________________ per year*12. Food Stamps $ ______________________________ per year*a. Medicaid received in 2009? o Yes o No13. Social Security income (SSA/SSD, etc.)(Provide documentation for all recipients in household.)a. Social Securtiy income (SSI ONLY)(Provide documentation for all recipients in household.)14. Student loans and/or grants received for PARENT’s education.(Not college attending dependents or students listed in Section C.)a. total received in 2009 $$ ______________________________ per year*$ ______________________________ per year*b. total used for household expenses $ ______________________________ per year*15. Housing Assistance (Sec. 8, HUD, etc.) $ ______________________________ per year*a. Religious Housing Assistance(parsonage, manse, etc.)$ ______________________________ per year*16. Other non-taxable income (Workers’ Comp., Disability,Pension/Retirement, etc. Identify source(s) in Section L) $ ______________________________ per year*17. Loans/Gifts from friends or relatives $ ______________________________ per year18. Personal Savings/Investment Accounts usedfor household expenses(Do not include totals listed in Section I)$ ______________________________ per year19. Total non-taxable income for 2009 $____________________________ per year*You must provide 2009 YEAR-END documentation for items 11-16; either a Year-EndStatement from the appropriate Public Agency, or documentation showing totals from1/1/09 - 12/31/09.JGo to next page _b. What is the amount still owed? $ __________________________________UNUSUAL CIRCUMSTANCESCheck all that apply to your situation within the past 12 months:a. o Loss of job i. o Death in the familyb. o Recent separation/divorce j. o Shared custodyc. o Change in family living status k. o High debtd. o Change in work status l. o Child support reductione. o Bankruptcy m. o Medical/Dental expensesf. o College expenses n. o Shared tuitiong. o Income reduction o. o Other (Explain in Section L)h. o Illness or injury
Page 1: Please note the required tax year d
Page 5 and 6: Detach herePRIVATE SCHOOL AID SERVI
Page 7 and 8: ALONG WITH YOUR APPLICATION YOU MUS

Student Aid Form â¢ 2010 - LycÃ©e FranÃ§ais de New York

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?

Student Aid Form â¢ 2010 - LycÃ©e FranÃ§ais de New York