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I. STUDENT'S INFORMATION Items denoted with * are required. *First Name: Middle Initial: *Last Name: *Email: Social Security #: - - Permanent Address: City: State: Zip: Phone Number: - - Birth Date: mm---010203040506070809101112 / dd---01020304050607080910111213141516171819202122232425262728293031 / Student is: U.S. Citizen eligible non-citizen neither During the academic year, student plans to live: with parents campus housing II. FINANCIAL INFORMATION Parents Last Year's Estimated Adjusted Gross Income: $ Estimated US Income Tax Paid: $ Father's Estimated Last Year's Wages: $ Mother's Estimated Last Year's Wages: $ Earned Income Credit: $ Estimated Untaxed Income: $ Cash and Bank Accounts: $ Other Real Estate Value: $ DO NOT INCLUDE PRIMARY RESIDENCE Other Real Estate Debt: $ Investment Value: $ Investment Debt: $ Farm/Business Value: $ Farm/Business Debt: $ Student Estimated Last Year's Adjusted Gross Income: $ Estimated US Income Tax Paid: $ Estimated Last Year's Wages: $ Estimated Last Year's Untaxed Benefits: $ Cash and Bank Accounts: $ Other Real Estate Value: $ Other Real Estate Debt: $ Investment Value: $ Investment Debt: $ III. FAMILY INFORMATION Family Size: Number of family members in college this year: Age of older parent: Student's state of residence: Parent's state of residence: Parent's marital status: Religious affiliation: Name of parent(s) or grandparent(s) who attended Newberry College and years of attendance:

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