• Date:
  
• Do you want a response via e-mail or phone?
  
• Student's SS#:
  
• Student's First Name:
  
• Student's Last Name:
  
• Street Address:
  
• City:
  
• State:
  
• County: (Michigan Residents Only)
  
• Zip:
  
• E-mail Address:
  
• Telephone:
  
• Fax:
  

You should enter the following information based upon you and your family's most recent federal tax return.

• Marital Status: (If divorced, use information from custodial parent)
  
• Age of Older Parent:
  
• Number in Household (Cannot be less than 2 for dependent student):
  
• Number of Children Attending College (including this child):
  
• Amount Paid Annually for Elementary/Secondary Private School Tuition (for other children)
  
• Parents' Total Earned Income:
  
• Untaxed Income/Benefits:
  
• Estimated Federal Income Tax Paid for Most Recent Year:
  
• Estimated State Income Tax Paid for Most Recent Year:
  
• Present Amount in Checking/Savings:
  
• Amount or Value of Investments (Do not include primary residence):
  
• Unpaid Debt on Other Real Estate/Investments:
  
• Value of Business/Farm (if applicable):
  
• Unpaid Debt on Business/Farm
  
• Any medical expenses (including dental and optical) not covered by insurance:
  

• Year in College:
  
• Adjusted Gross Income:
  
• Outside Scholarship Expected:
  
• Savings, Investments, Trusts: