Complete this form to estimate your ECF and begin personalizing your College Affordability Rating.

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Dependency StatusStudent InformationParents’ InformationResults

Answering 'No' to all questions indicates you are a dependent student.

1.	Will the student be 24 or older during the college year in question?	YesNo
2.	As of today, are you married? (Also answer “Yes” if you are separated but not divorced.)	YesNo
3.	At the beginning of the college year, will you be working on a master’s or doctorate program (such as an MA, MBA, MD, JD, PhD, EdD, graduate certificate, etc.)?	YesNo
4.	Are you currently serving in the armed forces or a veteran?	YesNo
5.	Do you have children or other dependents that receive more than half their support from you?	YesNo
6.	At any time since you turned age 13, were both your parents deceased, were you in foster care or were you a dependent or ward of the court?	YesNo
7.	Are you or were you an emancipated minor as determined by a court in your state of legal residence?	YesNo
8.	Are you or were you in legal guardianship as determined by a court in your state of legal residence?	YesNo
9.	At any time on or after July 1st of last year, did your high school or school district homeless liaison determine that you were an unaccompanied youth who was homeless?	YesNo
10.	At any time on or after July 1st of last year, did the director of an emergency shelter or transitional housing program funded by the U.S. Department of Housing and Urban Development determine that you were an unaccompanied youth who was homeless?	YesNo
11.	At any time on or after July 1st of last year, did the director of a runaway or homeless youth basic center or transitional living program determine that you were an unaccompanied youth who was homeless or were self-supporting and at risk of being homeless?	YesNo

Answer questions according to the student income and assets, not the parents.

1.	Were you required to file a 1040 for 2009?	Yes No Did Not File
1	In 2008 or 2009, did you (or your spouse) or anyone in your household (from question 6) receive benefts from any of the federal benefts programs listed? Mark all the programs that apply. Answering these questions will not reduce your eligibility for student aid or for these other benefts. Food Stamps or TANF may have a diferent name in your state. Call 1-800-4-FED-AID to fnd out the name of the state’s program.
	a.   Supplemental Security Income?	YesNo
	b.   Food Stamps?	YesNo
	c.   Free or Reduced Price Lunch?	YesNo
	d.   Temporary Assistance for Needy Families (TANF)	YesNo
	e.   Special Supplemental Nutrition Program for Women, Infants and Children (WIC)	YesNo
3.	As of today, are you (or your spouse) a dislocated worker?	YesNo
4.	What is your Age?	16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36
5.	What is your marital status as of today? I am single I am married/remarried I am separated I am divorced or widowed
6.	How many people live in your household?
7.	How many students from your household will be in college?
8.	What is your state of legal residence? Alabama Alaska American Samoa Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Mariana Islands Marshall Islands Maryland Massachusetts Mexico Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming
9.	Adjusted gross income?
10.	Earnings from work?
11.	Earnings from spouse’s work?
12.	Federal income tax paid?
13.	Value of cash, savings, checking accounts?
14.	As of today, what is the net worth of your (and spouse’s) investments, including real estate? Don’t include the home you live in. Net worth means current value minus debt.
15.	Value of other assets?
16.	Total Untaxed Income?

16.	Untaxed Income?
a.	Payments to tax-deferred pension and savings plans (paid directly or withheld from earnings), including, but not limited to, amounts reported on the W-2 forms in Boxes 12a through 12d, codes D, E, F, G, H and S.
b.	IRA deductions and payments to self-employed SEP, SIMPLE, Keogh and other qualified plans from IRS Form 1040—line 28 + line 32 or 1040A—line 17.
c.	Child support received for any of your children. Don’t include foster care or adoption payments.
d.	Tax exempt interest income from IRS Form 1040—line 8b or 1040A—line 8b.
e.	Untaxed portions of IRA distributions from IRS Form 1040—lines (15a minus 15b) or 1040A—lines (11a minus 11b). Exclude rollovers. If negative, enter a zero here.
f.	Untaxed portions of pensions from IRS Form 1040—lines (16a minus 16b) or 1040A—lines (12a minus 12b). Exclude rollovers. If negative, enter a zero here.
g.	Housing, food and other living allowances paid to members of the military, clergy and others (including cash payments and cash value of benefits). Don’t include the value of on-base military housing or the value of a basic military allowance for housing.
h.	Veterans noneducation benefits, such as Disability, Death Pension, or Dependency & Indemnity Compensation (DIC) and/or VA Educational Work-Study allowances.
i.	Other untaxed income not reported in items 45a through 45h, such as workers’ compensation, disability, etc. Don’t include student aid, earned income credit, additional child tax credit, welfare payments, untaxed Social Security benefits, Supplemental Security Income, Workforce Investment Act educational benefits, on-base military housing or a military housing allowance, combat pay, benefits from flexible spending arrangements (e.g., cafeteria plans), foreign income exclusion or credit for federal tax on special fuels.
j.	Money received, or paid on your behalf (e.g., bills), not reported elsewhere on this form.
17. Student’s 2009 Additional Financial Information (Enter the combined amounts for you and your spouse.)
a.	Education credits (American Opportunity, Hope and Lifetime Learning tax credits) from IRS Form 1040—line 49 or 1040A—line 31.
b.	Child support paid because of divorce or separation or as a result of a legal requirement. Don’t include support for children in your household, as reported in question 94.
c.	Taxable earnings from need-based employment programs, such as Federal Work-Study and need-based employment portions of fellowships and assistantships.
d.	Student grant and scholarship aid reported to the IRS in your adjusted gross income. Includes AmeriCorps benefits (awards, living allowances and interest accrual payments), as well as grant and scholarship portions of fellowships and assistantships.
e.	Combat pay or special combat pay. Only enter the amount that was taxable and included in your adjusted gross income. Do not enter untaxed combat pay reported on the W-2 (Box 12, Code Q).
f.	Earnings from work under a cooperative education program offered by a college.

1.	Are both parents still living?	Both Only Father Only Mother
2.	Did your parents required to file a 1040 for 2009?	Yes No Did Not File
3.	In 2008 or 2009, did you, your parents or anyone in your parents’ household (from question 7) receive benefts from any of the federal benefts programs listed? Mark all the programs that apply. Answering these questions will not reduce your eligibility for student aid or for these other benefts. Food Stamps or TANF may have a diferent name in your parents’ state. Call 1-800-4-FED-AID to fnd out the name of the state’s program.
	a.   Supplemental Security Income?	YesNo
	b.   Food Stamps?	YesNo
	c.   Free or Reduced Price Lunch?	YesNo
	d.   Temporary Assistance for Needy Families (TANF)	YesNo
	e.   Special Supplemental Nutrition Program for Women, Infants and Children (WIC)	YesNo
4.	As of today, is either of your parents a dislocated worker?	YesNo
2.	How many parents are currently employed?	0 1 2
3.	What is the Oldest Parent's Age?	26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64
4.	How many people live in the household?
5.	How many students from your household will be in college?
6. What is your parents’ state of legal residence? Alabama Alaska American Samoa Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Mariana Islands Marshall Islands Maryland Massachusetts Mexico Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming
7.	Adjusted gross income?
8.	Earnings from work?
9.	Earnings from spouse’s work?
10.	Total Untaxed Income?
11.	Federal income tax paid?
12.	Value of cash, savings, checking accounts?
13.	As of today, what is the net worth of your parents’ investments, including real estate? Don’t include the home you live in. Net worth means current value minus debt.
13.	Value of other assets?

13. Untaxed Income?
a.	Payments to tax-deferred pension and savings plans (paid directly or withheld from earnings), including, but not limited to, amounts reported on the W-2 forms in Boxes 12a through 12d, codes D, E, F, G, H and S.
b.	IRA deductions and payments to self-employed SEP, SIMPLE, Keogh and other qualified plans from IRS Form 1040—line 28 + line 32 or 1040A—line 17.
c.	Child support received for any of your parents’ children. Don’t include foster care or adoption payments.
d.	Tax exempt interest income from IRS Form 1040—line 8b or 1040A—line 8b.
e.	Untaxed portions of IRA distributions from IRS Form 1040—lines (15a minus 15b) or 1040A—lines (11a minus 11b). Exclude rollovers. If negative, enter a zero here.
f.	Untaxed portions of pensions from IRS Form 1040—lines (16a minus 16b) or 1040A—lines (12a minus 12b). Exclude rollovers. If negative, enter a zero here.
g.	Housing, food and other living allowances paid to members of the military, clergy and others (including cash payments and cash value of benefits). Don’t include the value of on-base military housing or the value of a basic military allowance for housing.
h.	Veterans noneducation benefits, such as Disability, Death Pension, or Dependency & Indemnity Compensation (DIC) and/or VA Educational Work-Study allowances.
i.	Other untaxed income not reported in items 93a through 93h, such as workers’ compensation, disability, etc. Don’t include student aid, earned income credit, additional child tax credit, welfare payments, untaxed Social Security benefits, Supplemental Security Income, Workforce Investment Act educational benefits, on-base military housing or a military housing allowance, combat pay, benefits from flexible spending arrangements (e.g., cafeteria plans), foreign income exclusion or credit for federal tax on special fuels.
18. Parents’ 2009 Additional Financial Information (Enter the amounts for your parent[s].)
a.	Education credits (American Opportunity, Hope and Lifetime Learning tax credits) from IRS Form 1040—line 49 or 1040A—line 31.
b.	Child support paid because of divorce or separation or as a result of a legal requirement. Don’t include support for children in your parents’ household, as reported in question 73.
c.	Your parents’ taxable earnings from need-based employment programs, such as Federal Work-Study and need-based employment portions of fellowships and assistantships.
d.	Student grant and scholarship aid reported to the IRS in your parents’ adjusted gross income. Includes AmeriCorps benefits (awards, living allowances and interest accrual payments), as well as grant and scholarship portions of fellowships and assistantships.
e.	Combat pay or special combat pay. Only enter the amount that was taxable and included in your parents’ adjusted gross income. Do not enter untaxed combat pay reported on the W-2 (Box 12, Code Q).
f.	Earnings from work under a cooperative education program offered by a college.

Your answers indicate that you are considered to be independent. These questions are not required.

Parents' Contribution for Student	$
Student's Estimated Contribution	$
Total Estimated FM Contribution	$