Gesher LaTorah Financial Aid Application 2017/18

2017/18

Student’s Name: Student’s Name: First Last
Email
Phone Phone - ### - ### ####
Student's Age:
Student's Address: Student's Address:
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Father's Name or N/A:
Father's Cell Phone or N/A:
Father's Address or Same or N/A:
Is Father Currently Employed Currently Employed?

Is Father Currently Employed Currently Employed? Yes No N/A
Is Father Currently Employed?

Is Father Currently Employed? Full Time Part Time
Father's Occupation or N/A:
Father's Work # or N/A:
Name and Address of Employer or N/A:
Mother's Name or N/A:
Mother's Cell Phone or N/A:
Mother's Address or Same or N/A:
Is Mother Currently Employed?

Is Mother Currently Employed? Yes No N/A
Is Mother Currently Employed?

Is Mother Currently Employed? Full time Part Time
Mother's Occupation or N/A:
Name and Address of Employer or N/A:
Mother's Work # or N/A:
Amount of Financial Aid You are Requesting: $ Dollars . Cents
The following information must be included for each child:
Name of child
Age
Living with family?(yes or no)
Name of school to be attended in 2017/18
Tuition and fees you will be paying
Anticipated scholarship amount you expect to receive
PLEASE ANSWER EACH QUESTION ON A SEPARATE LINE
How many dependent children do you have (including student)?
Child 1
Child 2
Child 3
Child 4
Child 5
Child 6
Child 7
Child 8
Child 9
Child 10
Parents' Annual Income and Expenses
Mother's Taxable Income (if N/A please enter 0): $ Dollars . Cents
Father's Taxable Income (if N/A please enter 0): $ Dollars . Cents
Dividend Income (if N/A please enter 0): $ Dollars . Cents
Interest Income (if N/A please enter 0): $ Dollars . Cents
Rental Income - real estate, boarders (if N/A please enter 0): $ Dollars . Cents
Other Taxable Income (if N/A please enter 0): $ Dollars . Cents
Nontaxable Income
SSI (if N/A then enter 0) $ Dollars . Cents
JFS (if N/A then enter 0) $ Dollars . Cents
What is it used for?
Other nontaxable income (if N/A then enter 0) $ Dollars . Cents
Expenses
Monthly mortgage/rent payment (if N/A then enter 0) $ Dollars . Cents
Medical and dental expenses not covered by insurance (if N/A then enter 0) $ Dollars . Cents
Health insurance premiums if not paid by employer (if N/A then enter 0) $ Dollars . Cents
Special education costs not paid by school system (e.g. tutors) (if N/A then enter 0) $ Dollars . Cents
Monthly automobile payment (if N/A then enter 0) $ Dollars . Cents
Other IRS itemized deductions(if N/A then enter 0) $ Dollars . Cents
Federal and State Income Tax Paid (if N/A then enter 0) $ Dollars . Cents
Other unusual expenses (if N/A then enter 0) $ Dollars . Cents
Please explain:
Parent's Assets and Debts
Do you Own or in the process of purchasing a home?

Do you Own or in the process of purchasing a home? Yes No
Estimate of present market value: $ Dollars . Cents
Unpaid mortgage/loan principle: $ Dollars . Cents
Purchase year:
Purchase price: $ Dollars . Cents
Other real estate investments (if N/A then enter 0) $ Dollars . Cents
Other investments - stocks, bonds and other securities) (if N/A then enter 0) $ Dollars . Cents
Total value of cash savings, checking and retirement accounts (if N/A then enter 0) $ Dollars . Cents
Describe the year and model of your automobile(s) or N/A:
Do you own a business?

Do you own a business? Yes No
Total business assets: $ Dollars . Cents
Total indebtedness of business: $ Dollars . Cents
Percent of ownership of business:
Do you have other outstanding debt?

Do you have other outstanding debt? Yes No
Please explain and provide your debt total as well as your monthly payments:
Please provide any other information you feel will be helpful to the financial aid committee:
Please upload your 2016 US Income Tax Returns. PLEASE BE SURE TO INCLUDE ALL SCHEDULES REQUIRED. If you own a business, in whole or in part, please upload all relevant tax forms as well.

Attach Files
Certification and Authorization

We declare that the responses to the above questions which we have provided Gesher LaTorah are true, correct and complete. We agree that to verify the information reported a copy of our 2016 U.S. Income Tax return is attached.
We further agree to provide, if requested, any other ethical documentation necessary to verify the information reported.
Draw your signature into the box below. (Parent/Guardian 1)

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.
Date Date / MM / DD YYYY
Draw your signature into the box below. (Parent/Guardian 2 or N/A)

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.
Date Date / MM / DD YYYY

Gesher LaTorah Financial Aid Application 2017/18

Gesher LaTorah Financial Aid Application 2017/18

The following information must be included for each child: Name of child Age Living with family?(yes or no) Name of school to be attended in 2017/18 Tuition and fees you will be paying Anticipated scholarship amount you expect to receive PLEASE ANSWER EACH QUESTION ON A SEPARATE LINE

Parents' Annual Income and Expenses

Nontaxable Income

Expenses

Parent's Assets and Debts

Certification and Authorization

The following information must be included for each child:
Name of child
Age
Living with family?(yes or no)
Name of school to be attended in 2017/18
Tuition and fees you will be paying
Anticipated scholarship amount you expect to receive
PLEASE ANSWER EACH QUESTION ON A SEPARATE LINE