12345 El Monte Rd. 21250 Stevens Creek Blvd.
Los Altos Hills, CA 94022-4599 Cupertino, CA 95014-5793
2017-2018 Net Worth Statement
Student’s Name______________________________________________________SID_________________________
Last First
Preferred Name (if different than above) _______________________________________________
Last First
Instructions: Net Worth equals current balance or market value minus debt.
List information that was accurate at the time you first submitted your 2017-2018 FAFSA.
List value, debt, and net worth for each business and real
estate property separately (include name and address for
each; use additional pages if needed). Note: If you are a
dependent student, we will assume each listing is for your
parents unless you indicate that it is yours.
Businesses: Under this heading, include market value of
land, buildings, machinery, equipment, inventory, etc. Do
not include a family farm (that you and/or your parents live
on) or a family business (one that your family owns and
controls more than 50%) with 100 or fewer full-time or full-
time equivalent employees.*
Real Estate: Under this heading, list real estate owned. If you are an
independent student, do not include the home you live in. If you are a
dependent student, do not include the home your parent(s) live in.*
Other Investments: Under this heading, write the total of the current
market value of each of your investments other than businesses or real
estate. “Other investments” include, but is not limited to, trust funds, UGMA
and UTMA accounts, money market funds, mutual funds, certificates of
deposit, stocks, stock options, bonds, other securities, commodities,
qualified educational benefits or education savings accounts. Do not
include life insurance, retirement plans, or cash, savings, and checking
accounts already listed in FAFSA questions #40 and #88.*
*See paper FAFSA instructions for questions 42, 43, 91, and 92 for more detail on what to include.
At the time I first submitted my 20172018 FAFSA, our business, real estate, and investment net worth was:
Businesses (For businesses, “debt” only includes debts for which the business or investment farm was used as collateral.)
Name: _______________________________ Name: _________________________________
Value: $__________________________ Value: $________________________________
Debt: $__________________________ Debt: $________________________________
Net Worth: $__________________________ Net Worth: $____________________________
Real Estate (If you need more space, please attach a separate sheet of paper.)
Address:______________________________ Address:________________________________
____________________________________ _______________________________________
Value: $_________________________ Value: $________________________________
Debt: $_________________________ Debt: $________________________________
Net Worth: $_________________________ Net Worth: $_____________________________
Other Investments: Add together the current market value of each investment (other than the business and real estate
investments listed above) to arrive at the “total current market value.” See instructions above for detail on what to include.
Total Current Market Value of All Other Investments of Student: $___________________
Total Current Market Value of All Other Investments of Parent(s): $___________________
I certify that the above information is true, complete, and accurate to the best of my knowledge.
____________________________ ____________ ___________________________________ ____________
tudent’s Signature Date Parent’s Signature (if dependent student) Date
t’s Name Printed