* Required

I.   STUDENT BIOGRAPHICAL DATA

(First, Last)​​
II.   PARENT INFORMATION
       (To be completed by the parent(s) you live with)
(First, Last)​​​
(First, Last)
III.   FAMILY MEMBER DATA
         Please list below:
  • Student and parents
  • Other siblings if parent(s) will provide more than half of their support for 2025-2026
  • Other people if they live in the household and parent(s) provide more than half of their support for 2025-2026      
(First, Last)​​​​
(First, Last)​​​​
(First, Last)​​​​
IV.   FINANCIAL DATA
Parent Expenses for Year 2024-2025
$​​
$​​​

Assets

$​​​
$​​​​
*Include trust/ mutual funds, stocks, bonds, etc.​​
What is it worth?
$​
$​
What is owed on it?
$​
$​
Year of purchase
Purchase price
Choose one​
$
$

Vehicle

Ownership Status of Vehicle

Total Taxable Income Before Taxes

Father's wages
$​​​​​​
$​​​​​​
Father's other wages
$​​​​​​
$​​​​​​
Dividend and/ or Interest Income
Alimony Received

Total Non-Taxable Income

Child Support Received
$​​​​​
$​​​​​

Disability/ Relevant Benefits

$​​​​​
$​​​​​
Parent Expenses for Year 2024-2025
$​​
$​​​

Assets

$​​​
$​​​​
*Include trust/ mutual funds, stocks, bonds, etc.​​
What is it worth?
$​
$​
What is owed on it?
$​
$​
Year of purchase
Purchase price
Choose one​
$
$

Vehicle

Ownership Status of Vehicle

Total Taxable Income Before Taxes

Mother's wages
$​​​​​​
$​​​​​​
Mother's other wages
$​​​​​​
$​​​​​​
Dividend and/ or Interest Income
Alimony Received

Total Non-Taxable Income

Child Support Received
$​​​​​
$​​​​​

Disability/ Relevant Benefits

$​​​​​
$​​​​​
V.   Special Circumstances/ Explanations
(Please attach a separate sheet if needed)
We declare that the information reported on this form is true, correct and complete. A copy of the parent(s) most recent TD4 must accompany this statement.
Max file size: 10 MB

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