Investments | Guaranteed Income | College Planning
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**All information provided is confidential and is not provided to any third party entities.
Not all fields are marked as "required" (*), however please enter as much information as possible to ensure you receive the most accurate estimate.
If you would like to complete a paper copy of this questionnaire, just ask! Send your request to firstname.lastname@example.org.
Did you attend one of our College Planning classes?*
If Yes, When did you attend our class?
Date of Birth*
Student Home Address
Address Line 2
State of Legal Residence*
Date began living in State*
What high school do they attend?*
Student's Graduation Year*
What is their class rank?
What is their GPA?*
Have they taken the SAT or PSAT?*
If Yes: Math Score
Critical Reading Score
Have they taken the ACT?*
If Yes: What was their composite score?
Major courses of study (If undecided, please indicate)
Career choice (If undecided, please indicate)
Are they taking any AP classes (If yes, please indicate all classes)
Parent Step Parent Guardian Other
Employer / Job Title
Father's highest grade level:
Elementary High School College or Beyond
Mother's highest grade level:
Number of family members in your family*
Number of dependents*
Are both parents United States citizens?*
Taxable Income Father*
Taxable Income Mother*
Adjustments to Gross Income*
Federal Income Tax Paid*
Earned Income Credit*
Will your income change next year?*
If yes, please explain*
Please check boxes for all accounts that you own:*
Checking Savings CD T-Bills Bonds Tax Exempt Bonds Stocks Mutual Funds Trust Funds Custodial UGMA/UTMA Limited Partnerships
Student Education Assets
Education IRA/Coverdell ESA*
Prepaid tuition plan*
529 College Savings Plan*
401k or 403b (Father)*
401k or 403b (Mother)*
Market value of your home*
Year your home was purchased*
Debt (Mortgage) on home*
Monthly Principal & Interest Payment*
Do you own any additional properties?*
If 'yes', please list your additional properties here:*
Single Married Seperated Divorced
Year of separation
Other parent information:
According to court order, when will support for the student end?
Who last claimed the student as a tax exemption?
In which year was the student last claimed
Is there an education clause (agreement) in the divorce decree?
If 'yes', how much per school year?
By entering your name, you agree to the following statement:This information is accurate and complete to the best of our knowledge.
Father First Name*
Father Last Name*
Mother First Name*
Mother Last Name*
Your information is secure and will not be shared with anyone.