Buena Vista University - Independent Student Estimator

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Independent Student Information Form

2011-2012 Academic Year

All fields are required. Please fill out all fields before pressing submit. If there are any questions please contact the Office of Financial Assistance at finaid@bvu.edu or by phone at 800.383.2821.

1. Social Security Number:

2. Phone Number:

3. Name:
First:
Middle:
Last:

Address:

City:

State:

Zip Code:

E-mail Address:

4. Have you attended any other college or university after graduating from high school?

Yes No

If yes, what was your cumulative college GPA?
If yes, number of transfer credit hours:

5. While in college, where do you plan to live?

On campus
Off campus
With parents or relatives

6a. ACT composite score, if available:

6b. Combined SAT score, if available:

6c. Cumulative high school GPA:

6d. High school class rank:
out of

6e. Month/Year of High School Graduation:

6f. Name of High School:

7. What is your current marital status?

Married
Unmarried (single, divorced, separated, or widowed)

8. Your date of birth: (mm/dd/yyyy)

9. Your state of legal residence:

10. Number of family members in 2011-12:
(Enter the number of people you will support between July 1, 2011 and June 30, 2012. Include yourself, your spouse, and children who will get more than half of their support from you. If you support others, include them if you will provide more than half of their support and that support will continue.)

11. Number of college students in 2011-12:
(Of the people included in question 10, how many will be enrolled at least half-time in college degree or certificate programs between July 1, 2011 and June 30, 2012? Be sure to include yourself.)

12. For 2009, you filed a:
Form 1040
Form 1040A or 1040EZ
No tax return was filed (Skip to question 16)
(If you filed an IRS Form 1040 for 2009 but will be eligible to file a 1040A or 1040EZ for 2010, or if you use a 1040 Telefile, check the box for Form 1040A or 1040EZ.)

13. 2009 Adjusted Gross Income:
(Form 1040 line 37, 1040A line 21, or 1040EZ line 4)

14. 2009 Federal tax paid:
(Form 1040-line 56, or 1040A-line 35, or 1040EZ-line 11.)

15. 2009 Itemized deductions:
(Enter zero (0) if a Form 1040A or 1040EZ was filed.)

16. 2009 income earned from work:
Student:
Spouse:
If you answered questions 13 through 15, include amounts you and your spouse earned from working in 2009 from your 2009 Form 1040-lines 7, 12, 18, and box 14 of schedule K-1; or Form 1040A-line 7; or Form 1040EZ-line 1. Report your and your spouse's earnings separately. (If you skipped questions 13 through 15, include your and your spouse's earnings from work in 2009. Add up earnings from your and your spouse's W-2 forms and other earnings from work that are not reported on W-2 forms.)

17. Total untaxed income:
Include any tax-deferred IRA, Keogh, 401(k), and 403(b) plan payments made in 2009, including amounts reported on W-2 Forms in boxes 12a-12d; codes D,E,F,G,H, and S, untaxed portions of pensions and IRAs, 2009 nontaxable interest and dividends, housing, food or other living allowances paid to members of the military, clergy or others, child support, workers' compensation, etc. received in 2009.

18. Exclusions to income:
The following should be included as an income exclusion, thereby increasing aid eligibility:

Child support paid because of a divorce or separation (do not include support paid for any child included in the family size in question 10)
Education credits (Hope and Lifetime Learning Tax credits
Taxable earnings from federal work study programs
Other student grant and scholarship aid reported in adjusted gross income

19. How much will your 2010 income change (+ or -) from 2009?
Increase Decrease
Your financial aid eligibility for 2011-2012 will be based on your 2010 income. Write in the amount that you expect your and your spouse's income to increase or decrease between 2009 and 2010. Be sure to add a "+" for an expected increase or a "-" for an expected decrease.

20. Cash, savings, and checking accounts:
(Value as of today. Do not include lump sum pension funds.)

21. Real estate and investments:
Today's market value minus debt. Include real estate (other than your home), trust funds, money market funds, mutual funds, certificates of deposit, stocks, bonds, other securities, installment and land sale contracts, commodities, UGMA, UTMA, JTTEN, Coverdell savings accounts, the refund value of 529 state prepaid tuition plans, and 529 plans, etc. minus any debt that is related to these assets. Do not include the value of life insurance and retirement plans (pension funds, annuities, non-educational IRAs, Keogh plans).

22. Business or farm equity:
(Today's market value minus debt. Do not include a family farm if it is your principal residence and your parents participate in its operation. Also, do not include the value of a small business that your parents own that has 100 or fewer full-time employees.)

Please retype the above letters: Required