2019 CH Parent Financial Summary and Tax Form

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Instructions: College Horizons requires parents to complete the following financial summary as well as submit a copy of the parent's 2017 OR 2018 tax return information. In a separate envelope, send us your payment for the application fee and refundable program deposit, all signed program waivers, the cover sheet, and a photocopy (not the original) of your entire Federal 1040 Tax Return. Please block out any social security numbers, but do not block out names of family members. Please label all documents with your student's first and last name. Please refer to the CH Application Instructions and Waivers document for further info and complete explanation.

Important: If parents are divorced, separated, not married and living together, or single, we request (if possible) that the Federal 1040 Tax Return and Parent Financial Summary & Tax Form be completed by BOTH the custodial and non-custodial parents. We need to understand the structure of both families in order to provide your family accurate financial aid counseling.

Please send this documentation to us at the following address:
Amelia Caté, Program Associate
College Horizons
PO Box 1262
Pena Blanca, NM 87041
Basic Info

Income Tax Filing

Family Structure for Financial Aid Counseling

Expected Family Contribution Worksheet
This REQUIRED information is used to calculate the Expected Family Contribution (EFC). These questions are asked on the FAFSA Form and are taken from the collegeboard.org EFC Calculator to determine federal aid eligibility.

Federal Assistance & Dislocated Worker

Financial Hardship


Please indicate the relationship and age for each family member in the parents' household below - to add a person(s), click the "Add a person" button on the lower left corner of this grid.

Relationship: Mother; Age: 45
Relationship: Brother; Age: 10
Relationship: Age
Household Member
Household Member
Household Member
Household Member
Household Member

How many siblings listed on the tax return are currently in college? (Do not include siblings who file as independents)

Based on info from your 2017 or 2018 filed income tax return(s):
Please enter dollar amounts into the boxes below, rounded to the nearest dollar.
1. What was your Adjusted Gross Income (AGI) for parent(s) and student? Enter below (refer to your tax return - 1040 line 37; 1040A line 21; 1040EZ line 4).

2. How much WORK earnings are included in your AGI?

3. How much TAXABLE COMBAT PAY is included in your AGI?

4. How much UNTAXED INCOME/BENEFITS is included in your AGI?

5. How much did you PAY OUT in child support for, dependent children living outside the student's home?

6. Did you receive any EDUCATION TAX CREDIT (American Opportunity Tax Credit or Lifetime Learning Tax Credit), how much?

7. Total US Income Tax OWED? (1040 line 55; 1040A line 39; 1040EZ line 10)

8. Total of CASH, SAVINGS, CHECKING accounts (exluding retirement accounts)?

9. Value of all real estate and investments (excluding the home in which you and your student lives)?

Business/Farm Questionnaire