Supplemental Information Form

Supplemental Information Form for the 24-25 School Year

Section A: Student Information

Student's Name:

First Name

Middle Name (optional)

Last Name

Permanent Address:

Address Line 1

Address Line 2

City

State

ZIP Code

Social Security Number:

A student's eligibility for need-based financial aid is determined by the student's/spouse and/or parent's income and assets from the prior calendar year (2022 for the 2024-2025 award year) based on information provided on the 2024-2025 FAFSA (Free Application for Federal Student Aid). However, adjustments can be made if the family's financial situation changes or if the family incurs unusual expenses for any of the following reasons.

Section B: Request for Special Consideration Based on Special Circumstances

1. Reduction in income - Estimate 2023 income below if there has been (or will be) a reduction from income in 2022. Please determine unemployment benefits before projecting income due to job loss.

A: Father's projected 2023 earnings: $

B: Mother's projected 2023 earnings: $

C: Student's projected 2023 earnings: $

D: Student's spouse's projected 2023 earnings: $

E: Severance package if applicable: $

F: Projected unemployment compensation: $

G: Other projected taxable income in 2023: $

Interest, dividends, alimony received, capital gains (or losses), ext.

H: Total income: $

Sum of lines A - G

I: Projected untaxed income: $

Include the same types of income identified on question #94 of the FAFSA

J: Total projected income for 2023: $

Sum of lines H-I

2. High cost of living - please indicate the city and state (or province) in which you live:

Explain the factors that contribute to the high cost of living in your area.

3. Exceptional health care expenses:

Please itemize and explain exceptional medical and/or dental expenses paid in 2021. Do not include expenses paid by health savings or flex spending accounts.

4. Degree-seeking parent enrolled in college

Supporting documentation for college enrollment:

No File Chosen

File uploads may not work on some mobile devices.

5. Are there children (K-12) in the household that have tuition cost for their schooling?

Yes No

If yes you will be asked to fill out the elementary and secondary tuition section

6. Other special circumstances

Please itemize, providing specific dollar amounts and explanation of any other unusual circumstances.

Elementary / Secondary Tuition

Indicate the total tuition paid in 2023 - 2024 for children in grades K-12:

Name of Child

First Name

Last Name

Name of School

Grade

Tuition $

Name of Child

First Name

Last Name

Name of School

Grade

Tuition $

Name of Child

First Name

Last Name

Name of School

Grade

Tuition $

Name of Child

First Name

Last Name

Name of School

Grade

Tuition $

A: Total Tuition $

Reductions to Tuition Charges - List any tuition assistance received from:

Church: $

School: $

Student scholarships / financial aid

T.R.I.P.: $

Tuition Reduction Incentive Program

Other: $

grandparents/other family members, friends, fund-raisers, etc.

B: Total Reductions $

Total Tuition you will pay $

Subtract total reductions (B) from total tuition (A)

Section C: Certifications

I/We certify that all of the information on this form is true and complete

to the best of my/our knowledge.

Student Signature*

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Date*

Parent Name

First Name

Last Name

Parent Signature

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Date

Spouse Name

First Name

Last Name

Spouse Signature

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Date