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2011-2012 Canadian dependent student financial aid form at Goshen College Please complete the 2011-2012 Canadian dependent student financial aid form. This form allows the Goshen College Student Financial Aid Office to evaluate Canadian students for any need-based Goshen College funds. When completing the items below, report all dollar amounts in Canadian currency. Some Canadian students, because they were born in the United States or because their parents are U.S. citizens, have United States citizenship. These students must request the Free Application for Federal Student Aid (FAFSA) used to establish eligibility for U.S. government assistance. This form is available from the GC Admissions Office or the Student Financial Aid Office. Please complete this document accurately. It must be accompanied by a 2011-2012 Goshen College Financial Aid Application. Also please attach a copy of the 2010 Canadian tax form(s) that reflect information entered on this document. Student’s information 1. Name___________________________________________________________________________ Student number _____________ (Please print) 2. Social Insurance Number (Canada):______-_____-________ Social Security Number (US): ______-_____-________ If you answer yes to any question # 3 – 6 below, you are considered an “Independent” student and need to fill out the Goshen College 2010-2011 Canadian Independent Student Financial Aid form (contact us at 1-800-348-7422 for the form.) 3. Were you born before Jan. 1, 1988? Yes No 4. Are you married? Yes No 5. Are you a ward of the court or an orphan? Yes No 6. Do you have legal dependents (other than a spouse)? Yes No 7. Student’s 2010 taxable income (including interest) ...................................................................................................................................... $ Earned income from work (salary, wages, tips) ............................................................................................... $ 8. Canadian federal income taxes paid in 2010 ................................................................................................................................................. $ 9. Student’s 2010 untaxed income (not listed in #7 above) ............................................................................................................................ $ 10. Student’s assets (cash, savings, checking accounts, C.D.s, real estate, other investments) ................................................................... $ (Over) Parents’ information 1. Marital status .................................................................................................. 2. Age of older parent ........................................................................................................................................................................................................... 3. a. How many persons in your family (including applicant) are living at home? ..................................................................................................... b. Not including parents, how many of these will be enrolled at least half-time in college (university)during 2011-2012? ..................................................................................................................................................................................... 4. Parents’ 2010 taxable income (including interest) ........................................................................................................................................ $ a. Father’s earned income (from work) ..................................................................................................................... $ b. Mother’s earned income (from work) ................................................................................................................... $ c. Pension Income ........................................................................................................................................................ $ d. Taxable income from other sources ...................................................................................................................... $ 5. Canadian federal income taxes paid in 2010 ................................................................................................................................................. $ 6. Parents’ 2010 untaxed income including Guaranteed Income Supplement, monthly allowance, board, gratuities such as a clergy housing allowance (not included in # 4 above) .......................................... $ 7. Single Married Separated Parents’ assets a. Cash, savings, checking accounts ........................................................................................................................... $ Divorced Widowed Current Market Value Amount Owed b. Other investments (not including retirement account) ....................................................................................... $ $ c. Other real estate (not including the home you live in)........................................................................................ $ $ d. Investment farm/business value ............................................................................................................................ $ (do not include a farm you live on and operate, or business if less than 100 employees) $ Certification: This information is accurate and complete to the best of my knowledge. Student’s signature: Date Parent’s signature: Date: Goshen College Nondiscriminatory Policy: Goshen College is in compliance with all applicable Federal regulations pertaining to nondiscrimination on the basis of handicap, sex, race, color, national or ethnic origin in its recruitment, admissions, educational, athletic, financial aid, and employment policies and programs. Please return to: Ca-dep c 02/28/11 Student Financial Aid Office Goshen College 1700 South Main Street Goshen, IN 46526 Federal School Code: 001799 Phone: (574) 535-7525 Toll free: (800) 348-7422 Fax: (574) 535-7654 E-mail: finaid@goshen.edu www.goshen.edu