COLLEGE FINANCIAL Mail Completed Questionnaire to: PLANNING QUESTIONNAIRE Second Tassel Scholarship Services Department RCA Computer Processing Fee:$89 PO Box 2207 Littleton CO 80161 HL32 ============================================================================ ALL INFORMATION PROVIDED FOR THIS REPORT WILL BE HELD IN THE STRICTEST CONFIDENCE AND WILL NOT BE SHARED WITH ANY SCHOOL OR AGENCY UNLESS YOU INSTRUCT US TO DO OTHERWISE. ============================================================================ ---------------------------------------------------------------------------- Section A STUDENT INFORMATION ---------------------------------------------------------------------------- 3. DATE 1. NAME _._._._._._._._._._._._._._._._ _._._._._._._._._._._. _. __/__/__ Last 2. First MI mm/dd/yy 4. MAILING _._._._._._._._._._._._._._._._._._._._._._._._._._._._. ADDRESS Number, street and apartment number _._._._._._._._._._._._._._._._._. _._. _._._._._. 5. City 6.State 7.ZIP code 8. Date of Birth __/__/__/ 9. Sex _/M _/F 10. State of Legal Residence _._. mm/dd/yy 11. Are you a U.S. Citizen _/Yes _/No 12. If not, have you applied for citizenship? _/Yes _/No 13. Marital Status _/Single _/Married _/Divorced/Separated _/Widowed List your first three choices of schools you would like to attend. BE SPECIFIC. DO NOT USE ABBREVIATIONS. 14. State________________________ School____________________________________ 15. State________________________ School____________________________________ 16. State________________________ School____________________________________ Copyright(C), 1988 College Financial Planning Service All Rights Reserved. Page 1 ---------------------------------------------------------------------------- Section B STUDENT'S FILING STATUS ---------------------------------------------------------------------------- 17. Did you or will you live with your parents for more than 6 weeks in any of the following years: 1985: _/Yes _/No 1986: _/Yes _/No 1987: _/Yes _/No 1988: _/Yes _/No 18. Did you or will you receive more than $750 in financial support from your parents in: 1985: _/Yes _/No 1986: _/Yes _/No 1987: _/Yes _/No 1988: _/Yes _/No 19. Were you claimed as a dependent on your parents' U.S. income tax return for any of the following years: 1986: _/Yes _/No 1987: _/Yes _/No 20. Will you be claimed by your parents as a tax deduction in: 1988: _/Yes _/No 21. Were you born before January 1, 1965?..............._/Yes _/No 22. Are you a veteran of the U.S. armed forces?........._/Yes _/No 23. Are you a veteran or ward of the court?............._/Yes _/No 24A. Do you have legal dependents other than a spouse?.._/Yes _/No ******If you answered YES to 24A, then answer 24B & 24C 24B. NOT including YOU or your SPOUSE, how many additional dependents do you have? _._. 24C. Including you, your spouse and any dependents, how many will be in college at least half-time during the... ......1987-88 school year _._. ......1988-89 school year _._. ......1989-90 school year _._. 25. Were your TOTAL income and benefits more than $4,000 in: 1986? _/Yes _/No 1987? _/Yes _/No 26. Will you have received a College Bachelors Degree prior to the 1988-89 school year? _/Yes _/No Copyright(C), 1988 College Financial Planning Service All Rights Reserved. Page 2 NOTE: If you are aged 24 or older as of December 31, 1988, OR, you are married, divorced/separated, or a widowed student who was not claimed as a dependent on your parents' 1986 or 1987 income tax return, you do not have to complete Section C. All others must complete this section. **************************************************************************** ---------------------------------------------------------------------------- Section C: PARENTS' HOUSEHOLD INFORMATION ---------------------------------------------------------------------------- 27. Parents' current marital status: _/Single _/Married or Re-married _/Divorced/Separated _/Widowed 28. Write in the age of your oldest parent. _._._. 29. How many family members will be in college at least half-time in: 1987-88 _._. 1988-89 _._. 1989-90 _._. 30. Write in the TOTAL number of persons in your parents' household. Be sure to include your parents, yourself, and all other dependents: _._. ---------------------------------------------------------------------------- Section D: STUDENT'S ESTIMATED INCOME FOR 1987 ---------------------------------------------------------------------------- 31. Will, or did, the student (and/or spouse, if married) file a U.S. income tax return for 1987? _/ YES _/NO 32A. Student's total income from work in 1987. If student is married, include income of spouse. DO NOT include income from College Work/Study Awards.............................A. For Student $___________ B. For Spouse $___________ 32B. Total of student's (and spouse) other taxable income in 1987 that was NOT included in 32A (passbook interest, dividends, etc.)......$_____________ 32C. Total exemptions claimed by student on income tax return......_________ 32D. Total income tax due or paid by student (and spouse) in 1987...$_______ 33. Student's (and spouse) UNTAXED income and benefits for 1987. This includes 1)un-taxed social security benefits, 2)welfare benefits, 3)child support. (DO NOT include any amounts already reported in questions 32A, 32B, 32C or 32D.)...................................................$____________ Copyright(C), 1988 College Financial Planning Service All Rights Reserved. Page 3 ---------------------------------------------------------------------------- Section E: STUDENT'S ASSETS ---------------------------------------------------------------------------- 34. If student (and/or spouse) expects to work during the 3-month summer of 1988, write in the total amount you expect to earn during summer vacation. A. Student $__________ B. Spouse $__________ 35. If student (and/or spouse) worked during the 9-month school year (9/1/1987 to 6/30/88), enter the amount of taxable income earned during that period: A. Student $__________ B. Spouse $__________ 36. How much do you think you will save from you summer earnings?..$________ 37. Student's total VA educational benefits for the period 7/1/87 to 6/30/88: $____________ 38. Enter the total value of any scholarships student has already received for the 1988-89 school year......................................$__________ ---------------------------------------------------------------------------- Section F: STUDENT'S ASSETS ---------------------------------------------------------------------------- 39. Enter TOTAL of student's assets, including savings, cash, stocks & bonds, investments, etc. DO NOT include money for student financial aid programs. $_____________ ---------------------------------------------------------------------------- Section G: STUDENT'S UNUSUAL MEDICAL EXPENSES ---------------------------------------------------------------------------- 40. Enter TOTAL of medical and dental expenses paid by student in 1987. Include insurance premiums. DO NOT INCLUDE any of these expenses which were paid by your parents. $____________ Copyright(C), 1988 College Financial Planning Service All Rights Reserved. Page 4 NOTE: If you are aged 24 or older as of December 31, 1988, OR, you are married, divorced/separated, or a widowed student who was not claimed as a dependent on your parents' 1986 or 1987 income tax return, you do not have to complete Section H, or I. All others must complete these sections. **************************************************************************** ---------------------------------------------------------------------------- Section H: PARENTS' INCOME ---------------------------------------------------------------------------- 41. FATHER's yearly wages, salaries and bonuses for 1987. $____________ 42. MOTHER's yearly wages, salaries and bonuses for 1987. $____________ 43. Parents' interest income for 1987. $____________ 44. Parents' dividend income for 1987. $____________ 45. Parents' social security benefits for 1987. $____________ 46. Parents' rent and royalty income for 1987. $____________ 47. All other taxable income for both parents NOT included in questions 41 through 46. (such as alimony, child support, pensions, aid to dependent families, etc.) $____________ 48. Parents' contributions to IRA's or Keogh in 1987. $____________ 49. Parents' 1987 adjusted gross income $____________ (IRS Form 1040-line 30; Form 1040A-line 12) ---------------------------------------------------------------------------- Section I: PARENTS' EXPENSES ---------------------------------------------------------------------------- 50. Moving expenses for 1987 (Form 1040-line 24) $____________ 51. Parents' deduction for married couple, both working. $____________ 52. Disability exclusion, parents' income taxes-1987. $____________ 53. Employee's business expenses, parents' income taxes-1987. $____________ 54. Total U.S. income tax paid by parents for 1987. $____________ 55. Primary and secondary school tuition paid by parents for other dependents in grades 1-12 (NOT this applicant) $____________ 56. Total medical and dental expenses for 1987 $____________ (insurance premiums, PLUS bills you paid). Copyright(C), 1988 College Financial Planning Service All Rights Reserved. Page 5 NOTE: If you are aged 24 or older as of December 31, 1988, OR, you are married, divorced/separated, or a widowed student who was not claimed as a dependent on your parents' 1986 or 1987 income tax return, you do not have to complete Section J. All others must complete this section. **************************************************************************** ---------------------------------------------------------------------------- Section J: PARENTS' ASSETS ---------------------------------------------------------------------------- 57. Parents' equity in home.(Renters enter 0) $____________ (What is you house worth MINUS what you owe the bank) 58. Other real estate equity owned by parents. $____________ 59. Business or farm equity. $____________ If you own a farm or business, you will be required to estimate its net worth. A close estimate of this number will be OK. DO NOT include "good will" in your estimate. 60. Total of parents' cash, savings, and checking accounts. $____________ 61. Other investments in parents' names(stocks, bonds, etc.). $____________ Copyright(C), 1988 College Financial Planning Service All Rights Reserved. Page 6 ---------------------------------------------------------------------------- STUDENT BACKGROUND QUESTIONNAIRE ---------------------------------------------------------------------------- This section asks you to tell us about your career interests, academic ability, talents, and club and religious affiliations. We will use this information to locate the source of private scholoarship programs that most closely match your individual circumstances. 1. CURRENT YEAR IN SCHOOL: CHECK ONE _/ High School Junior _/ College Junior _/ High School Senior _/ College Senior _/ College Freshman _/ Vocational Student _/ College Sophomore 2. CLASS STANDING: _/ Top 5% _/ Top 10% _/Top 25% _/Top 50% 3.CHECK UP TO 3 SUBJECTS THAT YOU ARE INTERESTED IN MAJORING IN AT COLLEGE: _/ Accounting _/ Marketing _/ Advertising _/ Mathematics _/ Aerospace _/ Medicine _/ Aeronautics _/ Military Science _/ Agriculture _/ Ministry _/ Architecture _/ Music _/ Art _/ Nursing _/ Biological Sciences _/ Nutrition _/ Business/Management _/ Paralegal _/ Chemistry _/ Physical Therapy _/ Crafts & Design _/ Physics _/ Communications _/ Political Science _/ Computer Science _/ Programming (Computer) _/ Dentistry _/ Psychology _/ Drafting _/ Publishing _/ Electronics _/ Public Administration _/ Engineering _/ Religion _/ Foreign Language _/ Social Science _/ Geology _/ Speech _/ Government _/ Teaching _/ Health Professions _/ Telecommunications _/ History _/ Theology _/ Humanities _/ Veterinary Medicine _/ Journalism _/ Zoology _/ Law _/ Other _______________________ _/ Literature 4. SPECIAL TALENTS OR HOBBIES: List up to 4 hobbies or special interests which you have: ____________________________________________________________ ____________________________________________________________________________ Copyright(C), 1988 College Financial Planning Service All Rights Reserved. Page 7 5.LIST ANY COMMUNITY CLUBS OR ORGANIZATIONS YOU ARE INVOLVED IN: ___________ ____________________________________________________________________________ ____________________________________________________________________________ 6. HAVE EITHER OF YOUR PARENTS SERVED ACTIVE DUTY IN THE U.S. MILITARY? _/ Yes _/ No IF YES, LIST DATES OF SERVICE: Father: From _________ To _________ Mother: From _________ To _________ 7. WOULD YOU LIKE TO ENTER A SCHOLARSHIP CONTEST? _/ Yes _/ No If yes, pick the one of these types of contests you would most like to enter: _/Writing _/Speech _/Art _/Music _/Drama _/Photography _/Foreign Language _/Math _/Science _/Debate 8. LIST ANY UNION OR TRADE ORGANIZATIONS THAT YOU OR YOUR PARENTS BELONG TO:_________________________________________________________________________ ____________________________________________________________________________ 9. ARE YOU A DESCENDENT FROM ONE OF THESE ETHNIC GROUPS? _/ Alaskan Native _/ Greek _/ Armenian _/ Hispanic _/ Black _/ American Indian _/ Portugese _/ Puerto Rican _/ Mexican/American _/ Vietnamese 10. ARE YOU A MEMBER OF ONE OF THESE CHURCHES? _/ Baptist _/ Lutheran _/ Brethren _/ Methodist _/ Catholic _/ Presbyterian _/ Christian Scientist _/ Mormon _/ Church of Christ _/ Religious Science _/ Foursquare Gospel _/ Reformed Church in America _/ Jewish _/ Unitarian Universalist PLEASE WRITE IN ANY ADDITIONAL INFORMATION YOU THINK MIGHT BE HELPFUL IN LOCATING SCHOLARSHIP OPPORTUNITIES THAT ARE OF SPECIAL INTEREST TO YOU:_____ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ Copyright(C), 1988 College Financial Planning Service All Rights Reserved. Page 8