115 South Street Middletown, NY 10940 (845)341-4190 fax (845)341-4194
1 Washington Center Newburgh, NY 12550 (845) 562-245 fax (845)220-4062
www.sunyorange.edu
2015-2016
ASSET INFORMATION WORKSHEET
First Name:__________________________ Last Name:_______________________
STUDENT INFORMATION
Net Worth of Investments . . . . . . . . . . . . . . . . . . . . . . . .
Net Worth of Business / Farm. . . . . . . . . . . . . . . . . . . . . .
Cash, Checking, and Savings . . . . . . . . . . . . . . . . . . . . . .
Electronic Certification Agreement. By providing your “electronic” student signature, student ID #
and by selecting the “Accept" button, you consent that all of the information reported is complete
and correct.
Student: Accept ___ Student Signature: _____________________________Date:___/___/_____
PARENT INFORMATION
(Dependent Students only)
Net Worth of Investments . . . . . . . . . . . . . . . . . . . . . . . . . .
Net Worth of Business / Farm. . . . . . . . . . . . . . . . . . . . . . . .
Cash, Checking, and Savings . . . . . . . . . . . . . . . . . . . . . . . .
Electronic Certification Agreement. By providing your “electronic” signature, selecting the
“Accept" button, you consent that all of the information reported is complete and correct.
Parent: Accept ___ Parent Signature: _____________________________Date:___/___/_____
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