OFFICE OF FINANCIAL AID
AND SCHOLARSHIPS
Check your myClackamas account for all financial aid correspondence and your Award Letter.
Secure submission of documents can be completed in person, by mail, or fax to:
Office of Financial Aid and Scholarships · Roger Rook Hall · 19600 Molalla Avenue, Oregon City, OR 97045
Phone: 503-594-6082 Fax: 503-722-5864 · e-mail: finaid@clackamas.edu · www.clackamas.edu
Need assistance? Financial Aid Resource Lab hours: Monday-Thursday, 10am-1pm and 1:30-3
12/19/18 Rd
2019-2020 ASSET INFORMATION WORKSHEET
(Summer Term 2019 Spring Term 2020)
Student Last Name
Student First Name
Student ID#
Date of Birth
Upon review of your verification documents, or due to a FAFSA rejection, we need to confirm the value of your assets. Please
follow the guidance provided below to assist you in providing this information. Please complete ALL information below as it
was on the date you first filed the 2019‐2020 FAFSA.
Refer to you and your parents’/spouse’s 2017 federal tax return. If a federal tax return form 1040 was filed, check for
dollar amounts listed on lines 8a, 8b, 9a, 12, 13, 17, or 18. If there is an amount on any of these lines, it is an indication of
potential assets to be reported on the FAFSA. Please list the dollar amount of any assets associated with the above line
numbers as of the date the FAFSA was completed.
NOTE: The dollar amount listed on the 1040 is NOT the same as asset net worth you list below. Net worth means current
value minus debt. If you have no amounts please write zero (0) in the boxes provided below, leaving no blanks.
A. Asset Values (do not leave any blanks)
PARENT(S) OR
SPOUSE
STUDENT
1. Total balance of cash, checking, and savings accounts:
$
$
2. Net worth of Investments (Examples: real estate, trust
funds, money market funds, mutual
funds, stocks, bonds, college savings plans, etc. Do not
include your primary residence, retirement accounts, or
life insurance):
$
$
3. Net worth of Investment Farm (Do not include if you or
your parent(s) live on it):
$
$
4. Do you own a business? (Choose YES or NO).
If "NO", skip to section B:
YES NO
YES NO
5. If “Yes” in box (4), does your business employ more
than 100 full‐time employees? (Choose YES or NO).
If “NO,” skip to section B:
YES NO
YES NO
6. Net worth of Business:
$
$
B. Certification Statement & Signatures
By signing below, I acknowledge that I have read and understand the information on this form, and certify that all
information submitted is accurate and true to the best of my knowledge.
_____________________________________________ _____________________
Student’s Signature Date
__________________________________________________ ________________________
Parent’s Signature (Required if Dependent Student) Date
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