February 23, 2012

Free Online Assessment

 

Please fill out this form. If you do not have all of the required data, submit what you can and we will get back to you later to get what's missing.

Family Information

Primary Info
Father's Name          
    First Name   Last Name   Age    
Mother's Name          
    First Name   Last Name   Age    
Student's Name        
    First Name   Last Name   Age   Current Grade

Additional Students
Additional Student        
    First Name   Last Name   Age   Current Grade
Additional Student        
    First Name   Last Name   Age   Current Grade
Additional Student        
    First Name   Last Name   Age   Current Grade

Contact Info
Phone      
    Home Phone   Father Cell   Mother Cell
Best Email      
Best Time To Call          

Student Academic Information

College Choices
State College Name
Academic Record
Grade Point Average   Class Rank
Overall GPA   out of students
Weighted GPA    

SAT
  Math Reading Writing Composite

ACT
  Math Reading Science Writing Composite

Student Income and Assets

Which Tax Return Does The Student File
What is the Student's Filing Status
Students Adjusted Gross Income
Student's Taxable Income
Federal Tax paid by Student
Student Farm/Business Net Worth

Student Assets   Total of All Sibling Assets
Type Amount   Type Amount  
Cash and Savings   Cash and Savings  
Trusts   Trusts  
Stocks   Stocks  
Bonds   Bonds  
Mutual Funds   Mutual Funds  
UGMA/UTMA   UGMA/UTMA  

Parent Income and Assets

Income and Tax Info

The following data fields are based on the 1040 tax return. If you are filing a 1040A or 1040 EZ the line numbers below will not apply to you.

Parent Filing Status   # in Household
Tax Return Filed   # of Exemptions
State of Residency      

  W-2 Income (form W-2) Business Income Re/Royalties/Trusts
  box 1 box 5
Line 12
Line 17
Father:
Mother:

Parents' Adjusted Gross Income (Line 37)
Parent's Itemized Deduction (Line 40)
Parent's Taxable Income (Line 43)
Federal Taxes Paid (Line 60)
   
Child support RECEIVED for all children
Child support PAID for all children
Housing, food, and other living allowances received
(members of the clergy, military, and others)
   
Did anyone in your household receive SSI, Food
Stamps, Free/Reduced Lunch, TANF, or WIC Benefits?
   
Assets and Real Estate

Qualified Assets (Retirement)
 
Type
Owner
Current Balance
Annual Contributions

Non-Qualified Assets (Non-Retirement)
 
Type
Owner
Current Balance

Personal Real Estate
Primary Residence    
  Home Value  
  Purchase Price Total P&I Payments
  First Mortgage Balance
  Second Mortgage Balance
  Home Equity Line of Credit Balance
Second Home    
  Home Value  
  Purchase Price Total P&I Payments
  First Mortgage Balance
  Second Mortgage Balance
  Home Equity Line of Credit Balance

Investment Property
Address
Property Value
Total Mortgage Debt
Total P&I Payments

Debts and Liabilities
Type Balance Payment

College Funding
How much per month can you afford to put toward college

Advisor Info
Do You Have A Current College Advisor? Who Is it?