Curry College 2012-2013 Family Information Form

Curry College2012-2013 Family Information FormDependent StudentReturn to: Curry College, Office of Student Financial Services, 1071 Blue Hill Avenue, Milton, MA 02186Tel: 1.617.333.2354 Fax: 1.617.333.2915 Email: fin-aid@curry.eduCurry College FAFSA Code: 002143Office use only□ NEW□ RET□ FILE□ PULL□ CREATE□ INC1. Student: _____________________________________ 2. Curry College ID#: @______________________________If known at the time of application3. Telephone: (_____)_____ - ____________ 4. New Student to Curry College (__) checkCell phone: (_____)_____-____________Returning Student to Curry College (__) check5. If you anticipate receiving any private sources of financial aid or tuition assistance (do not include Curry College Grant), please list thesource, type of benefit (scholarship/grant, loan) and expected amount of award. You must also provide official documentation of thisaward or benefit to the Office of Student Financial Services to receive credit on your student account.SOURCE: TYPE OF AWARD: EXPECTED AMOUNT:____________________________________________________________________________________________________________ $ ______________________________________________________________ $ ____________________FAMILY INFORMATION6. List the people in your household, including:* yourself and your parent(s) (including step-parent) even if you don’t live with your parents, and* your parents’ other children, even if they don’t live with your parent(s), if (a) your parents will provide more than half of theirsupport from July 1, 2012 through June 30, 2013 or (b) the children would be required to provide parental information when applying forFederal Student Aid, and* other people if they now live with your parents, and your parents provide more than half of their support and will continue toprovide more than half of their support from July 1, 2012 through June 30, 2013.Write the names of all household members in the space(s) below. Also write in the name of the college for any household member,excluding your parent(s), who will be attending at least half time between July 1, 2012 and June 30, 2013, and will be enrolled in adegree, diploma, or certificate program. If you need more space, attach a separate page.Name of each person in your household.Include yourself, your parent(s) and siblings if theymeet the criteria listed above.Relationship(father,mother,sister,brotherstep-parent, etc)AgeYr. inCollege(1 st ,2 nd ,3 rd ,4 th )College attending in2012-2013College Attendance(1/2 time is defined as 6-8credits per semester)Circle oneSelf Curry College Full-time Half-time

FINANCIAL DATA7. Parent(s) will file / have filed / will not file a 2011 tax return. Type of return: 1040 _____ ; 1040A / EZ / TEL ____Circle oneCheck one8. Student will file / have filed / will not file a 2011 tax return. Type of return: 1040 _____ ; 1040A / EZ / TEL ____Circle oneCheck one9a. How much did your parents earn from working in 2011? $_____________Answer this question whether or not a tax return was filed. This information may be on the W-2 forms, or on IRS Form 1040 – lines 7+12+18+Box 14of IRS Schedule K-1 (Form 1065): 1040A-line 7:or 1040EZ-line 19b. How much did you (the student) earn from working in 2011? $_____________Answer this question whether or not a tax return was filed. This information may be on the W-2 forms, or on IRS Form 1040 – lines 7+12+18+Box 14of IRS Schedule K-1 (Form 1065): 1040A-line 7:or 1040EZ-line 110. For the calendar year 2011 please answer each question below:* DO NOT LEAVE ANY QUESTION BLANK *IF THE QUESTION DOES NOT PERTAIN TO YOU PLEASE INDICATE $0.00 or N/AParent(s) 2011 Amounts Paid Student$a. Child Support PAID because of divorce or separation or as a result ofa legal requirement. Don’t include support for children in yourparents’ household$Parent(s) 2011 Untaxed Income Student$$$b. Child support RECEIVED for all children (don’t include foster care oradoption payments $c. Housing, food and other living allowances paid to members of themilitary, clergy and others (including cash payments and cash value of$benefits) Do not include the value of on-base military housing orallowanced. Veteran’s non education benefits such as Disability, Death, DeathPension or Dependency & Indemnity Compensation (DIC) and/or VA$Educational Work-Study allowances.$e. Other untaxed income not reported, such as unemployment, workerscompensation, disability, etc. $f. Food Stamp Benefits: Attach a copy of your Food Stamp Benefit Card$Asset Information11. Please list current values as of the date you completed the FAFSA. Do not leave responses blank, mark $0.00 or N/A where necessary.$Parent(s)Studenta. Cash, savings, checking accounts – as of the date the FAFSA wascompleted. $$$YES/NO circle oneb. Investments – as of the date the FAFSA was completed (stocks, bonds, trustfunds, money market funds, Educational IRA’s, etc.)c. Coverdell savings accounts, 529 college savings plans and the refund value of529 prepaid tuition plans.d. Do you own Rental Property or do you have rental income or rental loss on yourIRS Form 1040 – Schedule E?$$YES/NO circle one

IF YOU ANSWERED YES TO QUESTION 11D, CONTINUE TO QUESTIONS E– K. OTHERWISE, PROCEED TO QUESTION 12e. Give the address of each Rental property.__________________________________________________________If you own more than one RentalProperty you must complete thissection for each property address.Copy this page and complete for eachproperty owned. Please SIGN andDATE each copy__________________________________________________________YES / NO circle onef. Is that Rental Property your primary residenceYES / NO circle one___# Units/Apartmentsg. What is the total number of rental units (include the unit you live in if it is yourprimary residence)___# Units/Apartments$$$YEAR =h. What is the current market (cash) value of Rental Propertyi. What is the TOTAL amount you owe on this propertyj. What was the original purchase pricek. What was the year you purchased the property$$$YEAR =STATEMENT OF CERTIFICATION AND UNDERSTANDINGStudent and Parent MUST sign and date below.Applications not completed in its entirety will be returned and considered INCOMPLETE.As a result, you may jeopardize your eligibility for certain limited funds.12. By signing this document, I certify that all information reported to qualify for Federal and State aid is complete and correct.WARNING: If you give false or misleading information, you may be fined, be sentenced to jail, or both.____________________________________________________________Student Signature___________________________________Date____________________________________________________________Parent’s Signature___________________________________Date13. OPTIONAL - Please Read and SignCREDIT BALANCE AUTHORIZATIONI authorize Curry College to retain excess funds, including those resulting from Title IV Federal Funds, to pay any charges that may be assessed to myaccount.I understand that this authorization is valid for both the current and future academic periods. I have the right to modify or rescind this authorization forany reason and at any time.___________________________________________________________Student Signature___________________________________Date