Do not complete the following unless you have been instructed to do so.

Student's Name:

Date of birth:

Social Security Number:

Driver's License Number:

Student's Email Address:

Parent's Email Address:

Assets:

Checking Student:                Checking Parent:

Savings Student:                   Savings Parent:

Money Markets Student:      Money Markets Parent:

CDs Student:                       CDs Parent:

Mutual Funds Student:          Mutual Funds Parent:

Stocks Student:                    Stocks Parent:

Bonds Student:                     Bonds Parent:

Trust Funds Student:             Trust Funds Parent:

Residence Information:

Purchase price:

Year purchased:

Monthly mortgage payment:

First mortgage balance:

Monthly water/sewer payment:

Home equity loan:

Expenses:

Child support paid:

Total elementary/secondary school tuition:

Unreimbursed medical and dental expenses (including medical insurance payments):