PARENTAL INCOME STATEMENT PARENTAL INCOME STATEMENT (Must be completed by parents or legal guardians) Father,Male Guardian, Mother, Female GuardianStudent Name * RequiredStudent's Telephone * RequiredSchool Name * RequiredGrade Level * RequiredPlease enter a number from 9 to 12.Choose one of the following options * RequiredFatherMale GuardianMotherFemale GuardianName * Required First Middle Last Choose one of the following * RequiredHomeCellTelephone #: * RequiredHome Address: * RequiredCurrently Employed: * RequiredYesNoOccupation: * RequiredEmployed by: * RequiredNumber of years employed by firm: * RequiredHow much is your weekly gross income ($) * RequiredGross: Earnings before Tax Deductions How many hours per week do you work? * RequiredPlease enter a number less than or equal to 100.Check any that apply to student: * RequiredFather deceasedMother deceasedParents separatedParents divorcedParents never marriedGive MONTHLY amounts for each source of non-taxable income being received by your family from any of the following, including applicant’s shareI do not receive any non-taxable income. * RequiredInitialSocial Security * RequiredEnter AmountsPublic Aid * RequiredVeteran's BenefitsUnemployment BenefitsAlimony/Child SupportOther Non-Taxable Income(pension, retirement, etc.)Taxable Income Before Deductions(Use Figures from U.S. Tax Forms) Total 2018 Total 2019Father, Male Guardian $ Total 2018 $ Total 2019 Mother, Female Guardian $ Total 2018 $ Total 2019 Total Taxable Income * Required $ $ Please list below the dependent children and other individuals whom the parent/guardian supports. * RequiredNameAgeRelationshipSSN If there are any special family concerns that should be taken into consideration in the processing of this application for your child, please explain in the space below. Whenever possible, show why these problems affect you financially.What is the highest grade level achieved by your mother or female guardian?What is the highest grade level achieved by your father or male guardian?I declare, to the best of my knowledge, that the information on this financial statement in true, correct, accurate, and complete. I agree to provide additional documentation, if necessary, to verify that the information reported in this statement is true.Signature of Parent or Guardian * RequiredDate * RequiredMonth123456789101112Day12345678910111213141516171819202122232425262728293031Year202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920 This iframe contains the logic required to handle Ajax powered Gravity Forms.