College Planning Data Form

**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

Did you attend one of our College Planning classes?*

 Yes No

If Yes, When did you attend our class?

Student General Information

First Name*


Last Name*

Date of Birth*


 Male Female

Home Phone

Cell Phone


Student Home Address

Address Line 2



Zip Code


State of Legal Residence*

Date began living in State*

Student Academic Information

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?*

 Yes No

If Yes:   Math Score

Critical Reading Score

Writing Score

Have they taken the ACT?*

 Yes No

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)

Parental General Information

Father Information

First Name*


Last Name*


 Parent Step Parent Guardian Other

Date of Birth*

Employer / Job Title

Home Phone

Work Phone


Father's highest grade level:

 Elementary High School College or Beyond

Mother Information

First Name*


Last Name*


 Parent Step Parent Guardian Other

Date of Birth*

Employer / Job Title

Home Phone

Work Phone


Mother's highest grade level:

 Elementary High School College or Beyond

Family Information

Number of family members in your family*

Number of dependents*

Are both parents United States citizens?*

 Yes No

Parent Income Information

Taxable Income Father*

Taxable Income Mother*

Adjustments to Gross Income*

Federal Income Tax Paid*

Earned Income Credit*

Will your income change next year?*

 Yes No

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

Account Details*

Student Education Assets

Education IRA/Coverdell ESA*

Prepaid tuition plan*

529 College Savings Plan*

Retirement Assets

401k or 403b (Father)*

401k or 403b (Mother)*

IRA (Father)*

IRA (Mother)*

Annuity (Father)*

Annuity (Mother)*

Property Information

Market value of your home*

Year your home was purchased*

Purchase price*

Debt (Mortgage) on home*

Monthly Principal & Interest Payment*

Do you own any additional properties?*

 Yes No

If 'yes', please list your additional properties here:*

Marital Status Information

Marital status*

 Single Married Seperated Divorced

Year of separation

Divorce date

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?

 Yes No

If 'yes', how much per school year?

Confirmation of Information

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.

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