2018 Project STEM Application: Financial Information

Student for which this form is being completed:

Student Name: 

First:    Middle Last 


Parent's or Guardian's information of parent completing this application:

 First  Middle Last

Relationship to Student: 


Parent Email*    

*This email is important as we may need to contact you.

Education: What is the level of education you completed: 



In this comment box, enter any details you want to include about your education.

Employment: Describe your current employment or occupation:

Other parent information:


Relationship to student: 

Education: What is the level of education completed: 



In this comment  box, enter any details you want to include about his / her education.

Employment: Describe his/her employment or occupation: 


Financial Information:

1. 2018 Total Family Members:  

2. 2017 Total Income Parents:  

3. 2017 Income Earned from Work:





4. 2017 Untaxed income and benefits (yearly totals only):

Social Security Benefits*: 

*include all federal and state benefits including disability, food stamps, WIC, or any other.

Child Support received for all children: 


5. Money in cash, checking and savings accounts:




6. Parent(s) current marital status:  


7.  Number of people in student's household for 2017-2018 


8.  Number of college students in your parent(s)' household for 2017-2018 


If there is any financial information you would like for the Selection Committee to know in making a decision about stipend eligibility, please explain here: