The Financial Data section of the application should be completed by the employee. Adjusted Gross/Net Income and Total Federal Income Tax amounts should be reported from the employees’ most recently filed tax return or based on estimated information to be filed with the Internal Revenue Service (IRS) or the Canadian Revenue Agency (CRA). Dollar amounts should be reported in U.S. dollars for U.S. employees and Canadian dollars for Canadian employees.

Information should be provided for both parents when possible. If the student resides with only one parent, financial information must be received from the employee of the company sponsoring the scholarship program and from the parent who claims the child as a dependent for tax purposes. If a parent has remarried, the spouse’s information is required if the spouse is a legal guardian of the student, or claims the student as a dependent, or the student is included in the spouse’s benefit plan. If necessary, a separate printed Financial Data Form (PDF) may be submitted in order for one to be completed by each parent if they cannot submit data jointly in this section.

1. State/Province of Residence is the state/province where the parents reside and pay state/province income tax.
2. Adjusted Gross Income can be found on IRS FORM 1040 (U.S. applicants only) and is gross income reduced by specific adjustments allowed by law. For Canadian applicants, report CRA Taxable Income.
3. Total U.S. Federal/Canadian Federal Income Tax Paid includes the total amount of federal income tax to be paid to the IRS/CRA. This is not the amount withheld from the employee’s paycheck (the amount withheld should be adjusted by any refund or additional taxes due.) Do not report state/province income tax.
4. Total Income of parent(s) should be reported individually.
5. Yearly Untaxed Income and Benefits include any other income or benefits (i.e. social security, child support, etc.) not included in the adjusted gross income figure. Do not include untaxed contributions to retirement plans.
6. Medical, Dental and Prescription Drug Expenses not paid for by insurance. (includes copays, deductibles; excludes premiums)
7. Total Cash, Checking/Chequing, Savings, Cash Value of Stocks, etc., includes liquid assets that can be used for educational expenses. Do not include IRA, 401k, RRSP or other retirement plan funds.
8. Total Number of Family Members living in the household and primarily supported by the reported income may include:
   • the applicant
   • the applicant’s parents
   • other children living in the household
   • dependent college students living away from home
   • other people who live in the household and receive more than half of their support from the reported income
9. Marital Status is the current status of the person from whom the financial information is submitted.
10. Of the total number of family members on line 8, number of students attending college includes family members attending a two- or four-year college, university, or vocational-technical school at least half-time. Include the applicant in this number. Do not include parents.

NOTE: Any exceptions to providing financial information as instructed above must be submitted to Scholarship America in writing.