2011 Financial Statement Form printable pdf download

2011 Financial Statement Form

2011 Project SEED

Summer Research Program

Financial Statement Form: To be completed by parents or guardians

Applicant’s Name_________________________________________________________

Limited scholarship funds are available to help students participate who would otherwise be expected

to contribute to their family support during the summer. Stipends range from $110 to $2500 depending

upon financial need. (Summer II students are eligible to receive $3000 stipend). Should you be

accepted into the program, you will also be informed about your stipend determination.

The family of each student must submit this form and be prepared to submit a copy of this year’s tax

return if the student applicant is accepted into the program. It is generally easier to file taxes first and

use the tax return totals to complete this form.

Sign at the signature lines and mail this paper along with your school transcript/s.*

*Before mailing, use the information on this document to enter the online application system part 4!

Student Information:

First Name ___________________________ Last Name _______________________________ M.I. ____

Address ______________________________________________________________________________

City ________________________________ State __________________ Zip Code __________________

Telephone Number (_____)_________________ Social Security Number __________________________

THE PARENT OR LEGAL GUARDIAN SHOULD ANSWER THE FOLLOWING

QUESTIONS:

Father’s Name __________________________ Occupation_______________________

Mother’s Name _________________________ Occupation_______________________

1. 2010 Total number of family members

2. 2010 Total Income of parents

3. 2010 Income earned from work:

Student

Father

Mother

2011 Project SEED / Indiana A.C.S. Summer Research Program

Financial Statement Form

2011 Financial Statement Form