PEACHTOWN ELEMENTARY SCHOOL CONFIDENTIAL SCHOLARSHIP ASSISTANCE APPLICATION 2011-2012 Student name(s) __________________________________________________________ Parents whose income information is provided below: PARENT I
_______________________________SSN#________________________
PARENT II
_______________________________SSN#________________________
Parents’ Marital Status_____
Number in Household _____
Age of Older Parent _______
INCOME INFORMATION 2010 Adjusted Gross Income
(line 37, 1040; line 21,1040A; line 4, EZ)
___________
2010 Salaries and wages for parent I
____________
2010 Salaries and wages for parent II
____________
2010 Dividend and/or interest income
____________
2010 Other taxable income (alimony, net profit/loss from business)
____________
2010 Other non-taxable income (earned income credit, child tax credit child support, SS benefits, AFDC, VA benefits, etc.)
____________
2010 Federal income tax paid (line 60, 1040; line 37, 1040A; line 11, EZ)
____________
ASSET INFORMATION (Use today’s MARKET values) Cash, saving, checking accounts
____________
Current market value of home
____________
Total outstanding home mortgage (debt)
____________
Other real estate and investments
____________
Business value
____________
Business debt
____________