Widowed Parent Disclosure
Office of Financial Aid ▪ 100 East 8
Street ▪ PO Box 9000 ▪ Holland, MI 49422-9000
P: 616-395-7765 ▪ F: 616-395-7160 ▪ email@example.com ▪ hope.edu/financialaid
It is our understanding that your parent was recently widowed. To determine your 2020-21 eligibility for
financial assistance, we need financial information of your surviving parent.
Your parent is to complete the following items using only his/her information, even if a joint tax return
Date you were widowed: ___/___/____
A. Submit a signed copy of parents’ 2018 Federal Income Tax Return and copies of all W-2 forms.
B. Complete the following information
1. HOUSEHOLD INFORMATION:
a. Current number in household: _________
b. Current number of household members attending college in 2020-21 _________
2. UNTAXED INCOME & BENEFITS expected to be received during 2019 *
a. Welfare benefits (including TANF). Don’t include food stamps or subsidized housing $______
b. Social Security benefits received for all household members $______
c. SSI disability benefits $______
d. Survivor benefits (e.g. life insurance, pensions, VA benefits, etc.) $______
e. Worker’s compensation $______
f. Any other untaxed income or benefits. List source(s): _____________________ $______
*DO NOT INCLUDE THE FOLLOWING UNTAXED INCOME TYPES:
Workforce Investment Act Educational benefits, benefits from flexible spending arrangements (e.g.
cafeteria plans), or combat pay if you are not a tax filer.
3. ASSET INFORMATION for Surviving Parent: What was it worth at What was owed?
date you were widowed?
a. Cash, savings, & checking accounts: $__________
b. Investments (excluding retirement plans): $__________ $_________
c. Other real estate (excluding home): $__________ $_________
d. Business: Name _____________________ $__________ $_________
Is the business more than 50% family-owned and controlled? YES NO
Does the business have 100 or fewer full-time equivalent employees? YES NO
e. Investment farm: $__________ $_________
Does your parent “materially participate in the farm's operation”? YES NO