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Financial Assistance Worksheet Printable Version
 
  • Please use 2003 actual or estimated data based upon your parents' and your 2003 income tax returns to complete this financial assistance worksheet. If you plan to use 2002 tax returns as a guideline, please reflect any significant changes in data from 2002 to 2003 in your calculations.
  • This is only an estimate. Your actual eligibility for financial aid will be based upon the completion of a Free Application for Federal Student Aid (FAFSA), which is available from your high school or from Jamestown College after January 1, 2003.
  • If you are giving information about your stepparent, note that whenever this form says "parents," we also mean your stepparent.
  • Feel free to call the Admissions Office at (701) 252-3467, ext. 5562, or toll free at 1-800-336-2554, if you have questions as you complete this form.
 
 
Dependent Student and Family Information
 
Full Legal Name:    Male   Female   Email:
 

Last Name		  
First Name		  
Middle Name		  
Maiden Name
 
Permanent Home Address:
 

Street Address		  
City		  
State		  
Zip		  
(Area Code) Telephone
 
Date of Birth: / /   SSN: 
 
Parents' Marital Status:
* (If you live with a parent and step-parent, check "Married")
 
* Married    Single    Divorced    Separated    Widowed    Age of older parent: 
 
Number of people in household for 2003-2004
(include parents and all dependents): 		   Number of family members in college
for 2003-2004 (excluding parents): 
 
 
 
2003 Income / Asset Information
 
What type of tax return will be filed?   Student   Parents
   
 1040
 1040A
 1040EZ
 1040 Telefile
 Not Filing
 
 1040
 1040A
 1040EZ
 1040 Telefile
 Not Filing
 
Adjusted gross income   $    $ 
 
Federal income tax   $    $ 
 
Number of exemptions claimed              
 
Earned income credit   $    $ 
 
Earnings from working   $    Father $ 
Mother $ 
 
Other income/credit        
a. Social Security benefits (in student's or parent's name), earned income credit, additional child tax credit, welfare benefits
  $    $ 
 
b. Child support received, workers compensation, veterans noneducation benefits, clergy or military housing allowances, payments to tax-deferred pension or savings plans, etc.
  $    $ 
 
c. Child support paid, education tax credit amount, student grants, etc., already reported in AGI
  $    $ 
 
Current net worth of investments
(stocks, bonds, CD's, money market funds, real estate - excluding the home in which you live)		   $    $ 
 
Current net worth of business/investment farm
(students do not include the farm your parents live on and operate)		   $    $ 
 
Cash, checking and savings   $    $ 
 
 
 
 
 
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