Collegiate Funding Solutions

Student's Name - Optional: Student's State of Legal Residence (2 letter abbreviation, e.g., NC): Birth Year of Student: (YYYY) How many years until student enters college? Student's grade for current school year:

Student's GPA: Student's SAT Score:
ACT to SAT conversion table

Family Size When this student begins college, how many total children - including this child - will be in college, at least half time? Are or will your children attend private elementary/secondary school(s):

Yes No

When student is in college, will you be incurring private secondary school expenses?

Yes No

Age of the oldest parent: Tax return filed: parents' marital status:

Note for divorced parents - In the following sections, parental income and assets for a student whose parents are divorced or separated, but not remarried, is determined by including only the income and assets of the parent who provides the greater portion of the student's financial support. If the parents are remarried, include info for the parent who provides the greater portion of the student’s financial support and the stepparent, provided the student's parent and the stepparent are married as of the date of application for the award year concerned.

Enter the amount of child support received last year due to divorce or separation: Enter the amount of child support paid last year due to divorce or separation:

Note - If your student is a senior in high school in 2023/2024, income information from your 2022 tax return will be used to determine your financial aid eligibility for their freshman year in college.

	Parent	Spouse	2022 IRS 1040 line #
Total W2 Gross Wages			line 1z
Self-employment (business/farm) Income			Sch 1 line 3 + 6
Adjusted Gross Income			line 11
Federal Income tax			line 24

Is either parent an executive?

Yes No

Does either parent expect a significant increase in salary or a bonus?

Yes No

Does either spouse have access to a qualified (ISO, ESOP) stock option plan?

Yes No

Does either employer pay for work-related expenses such as travel, meals, items purchased for work, etc.?

Yes No

Does either employer offer a SECTION 125 (Cafeteria) plan?

Yes No

Did you have extraordinary income or loss (bonus, unemployment, etc.) during the year?

Yes No

Parent's Extraordinary Income Amount
(for loss use -):

Did you have any extraordinary expenses (medical, business, etc.) during the year?

Yes No

Parent's Extraordinary Expense Amount

Total non-reimbursed medical expenses last year
(include premiums, co-pay, etc.)

Parent & Spouse 2022 IRS 1040

Taxable Interest Income line 2b Dividend Income line 3b Other Taxable Income Schedule 1 line 9 Taxable Refunds schedule 1 line 1 Alimony Recieved Schedule 1 line 2a Capital gain (loss) line 7(use - sign to enter loss) Taxable IRA distribution Portion from line 4b Taxable Pension/Annuity Distribution Portion from line 5b Parent's Real Estate/Schedule E Income (loss) Schedule 1 line 5 (use - sign to enter loss)

Sum each of the following amounts that apply to your situation and enter the total below:

IRA deductions and payments to self-employed SEP, SIMPLE, Keogh, and other qualified plans:
Tax Exempt Interest Income
Foreign Income Exclusion
Untaxed portion of IRA distributions and untaxed portion of pensions (excluding rollovers):

Total:

Note - In this next section you will be asked for the value of assets. Depending on your responses, you will also be asked: "Dollar amount allocated for college for student in question?" This refers to the student described in the Student Information section at the begining of the form. Some assets that are allocated for college may be intended for more than one child. Therefore, when asked "Dollar amount allocated for college for student in question?", only include the amount that is available for the student for whom the report is being generated.

Savings

Savings allocated for college for student in question:

Checking Total Stock

Stocks allocated for college for student in question: Under Performing Stock

Total Bonds

Bond Type EE issued after 1989

Amount allocated for college for student in question:

Bond Type I

Amount allocated for college for student in question:

Bond Type H

Amount allocated for college for student in question:

Bond Type Other

Amount allocated for college for student in question:

Mutual Funds

Amount Allocated for college for student in question:

Coverdell Education Savings Accounts (CESA)

Education savings account total designated for the student in question (they are the beneficiary):

529 College Savings Plans

Education savings account total designated for the student in question (they are the beneficiary):

529 Prepaid Tuition Plans

Education savings account total designated for the student in question (they are the beneficiary):

Annuities (current value) Other Investments (exclude real estate which will be listed later) Trust Fund Amount (in name of parents only) Are you interested in learning about how trusts can help you with college-funding and estate planning?

Yes No

How would you describe your investing philosophy? Are you interested in removing assets from your estate that will appreciate in value?

Yes No

Retirement Accounts (Exclude assets already listed)	Parent	Spouse
Traditional IRA Balance
Amount contributed last year:
Simple IRA
SEP
Roth IRA
Amount contributed last year:
Company Retirement Acct Balance(401k, 403b, etc.)
What type of retirement savings plan do you currently have?
Are you contributing the max amount?	Yes No	Yes No
Amount contributed last year:
Stock Purchase / Incentive

Does your retirement plan include highly appreciated employer stock?

Yes No

Does your employer provide for a non-qualified deferred compensation plan?

Yes No

Does your employer provide for a deferred compensation plan?

Yes No

Do you own a home?

Yes No

Current Residence Value Current Residence Debt Are you planning any major purchases or home improvements?

Yes No

Original purchase price Year purchased

Do you own other real estate?

Yes No

Other Real Estate Value Other Real Estate Debt Parent's Other Real Estate Type

Second Home
Investment Real Estate

Does parent own a life insurance policy outside of any company provided benefit?

Yes No

Parent Section
Death Benefit	Cash Value	Type

Does spouse own a life insurance policy outside of any company provided benefit?

Yes No

Spouse Section
Death Benefit	Cash Value	Type

Does either spouse have a disability insurance policy through self-employment or employer?

Yes No

Is either spouse chronically or terminally ill?

Yes No

Do grandparents incur high medical expenses?

Yes No

Do you have a sick relative or a relative in a nursing home?

Yes No

Do Parents Own a Business?

Yes No

Do Parents Own a Farm?

Yes No

Investment farm net value (Enter the net value of your share of any investment farms(s) in which you have an interest) Family farm net value (The market value of only business portion of farm. Do not include the net value of the family's principal place of residence) Is the farm you own a working farm?

Yes No

If yes, does it sell agricultural commodities?

Yes No

How much are you able to allocate out of monthly cash flow for college savings/costs? Would you consider gifting money to your child to help pay for college?

Yes No

Are you interested in gifting more than the $17,000 ($34,000 for joint gifts) maximum for this year?

Yes No

If yes, to the above question, how much would you be willing to gift? (Don't exceed $170,000 if joint tax-filer or $85,000 for single tax-filer)

Are you interested in learning about ways to pay for college that will help you reduce your taxable estate?

Yes No

Are you interested in immediately (within next 2-4 years) reducing your taxable estate?

Yes No

Are you considering gifts to charities in the near future?

Yes No

Do grandparents have an interest in helping with college expenses?

Yes No

Do grandparents have a charitable intent?

Yes No

Would you consider loaning money to the student to pay college costs?

Yes No

W-2 Wages earned (If you are in college now, do NOT enter Work-Study income here) Adjusted Gross Income (AGI): (do not include annuities, life insurance, or retirement accounts) Student Untaxed Income Student Federal Tax Paid

Cash/Checking/Savings Real Estate Investments Net Home Equity Business Net Worth Trust Funds

Will student gain control of trust before January of Senior year in high school?

Yes No

Total Value of Siblings' Assets Has student been selected for any scholarships or awards?

Yes No

Amount

Annual College Inflation (format: .XX):

Enter the location of the school you would like to evaluate.

Student School Location Student School Name

Champion Financial TEAM

Helping Families Save ON the Cost of a College Education

SECURE DATA FORM

Simple steps to solving your college funding concerns

Student Information

Tell us about your family

Now, please tell us about you family income

Special income/loss questions

Tell us about your other taxable income

Tell us abour your tax-deferred or untaxed income

In this section are questions concerning the parents' assets

Now, a few questions about retirement accounts

Tell us about your real estate holdings

Tell us about your insurance and medical situation

Please tell us if you own a business or a farm

Here are some important college savings and funding questions

Almost done! Tell us about the student's income

Please tell us about the student's assets

Finally - get started by selecting a college of interest