Supplemental Data Worksheet - Benedictine College (Page 2 of 2) in pdf

Does your family contribute essential financial support to persons unable to be self-sufficient? This support may be

directed to parents in extended care homes or to unemployed/underemployed adult children. Write a brief synopsis of the

situation and provide annual costs associated with the situation and documentation of such expenses for 2015.

$___________________ Annual Cost

________________________________________________________________________________________________________

Did your family experience a one time bump or temporary increase in 2015 yearly income (capital gains, bonus, gaming

winnings, stock options, IRA withdrawal, etc.)? Write a brief synopsis and provide annual income associated with the

situation. Submit a copy of the 2015 Federal Tax Return showing the amount of such a gain.

$___________________ Amount of Increase

________________________________________________________________________________________________________

$_______________If your family paid funeral expenses in 2015 not covered by insurance or reimbursed.

10. $_______________If your family paid personal legal fees in 2015 (divorce, death, etc.) that are not tax deductible.

11. $_______________If your family paid adoption expenses in 2015 documented on IRS Form 8839 (submit a copy of form).

12. If one of the parents will be attending college with the intent of receiving a degree, please provide proof of enrollment;

indicate the parent’s name, college name, degree and the hours only if there is no tuition reimbursement from any source.

Name______________________________College___________________________Degree___________Fall Hrs____Spring Hrs____

This information will be used, in combination with your 2016-17 FAFSA, to determine student’s eligibility for Federal

Financial Aid and attempt to reflect student’s true ability to contribute toward their college education. Before this Special

Circumstances Worksheet can be used to evaluate your unique situation, you must file your 2016-17 FAFSA on-line at

In order to ensure maximum consideration of financial aid assistance, new students (beginning freshman and

transfers) must make application to the college, be accepted, and make your $300 enrollment deposit and complete your

FAFSA form prior to APRIL 1, 2016. Due to limited funding for need-based aid, awarding is on a first come, first served

basis.

Sign below to certify that the amounts used on this form are correct. You may be requested to provide proof (receipts,

cancelled checks, affidavits, etc.) of this statement’s information.

______________________________________________________

____________________________________________________

Parent’s Signature

Date

Student’s Signature

Date

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1020 North Second Street | Atchison, Kansas 66002 |

finaid@benedictine.edu

| (phone) 800.467.5340 | (fax) 913.367.5462

Supplemental Data Worksheet - Benedictine College Page 2