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NOTE: All information provided below will be used solely for the purposes of Gold Medal Swim Club scholarship determination.
Family
Parent(s) Name(s)
(Required)
Swimmer(s) Name(s)
(Required)
Phone
(Required)
Email
(Required)
Assets
PERSONAL ASSETS
Personal Residence
Auto
Personal
Other Personal Asset #1
Other Personal Asset #2
Other Personal Asset #3
LIQUID AND INVESTMENT CASH
Cash/Savings
Retirement Savings
TOTAL ASSETS
Total Assets
Liabilities
LIABILITY BALANCE
Home Mortgage
Auto Loan
Credit Card
Other Debt #1
Other Debt #2
Other Debt #3
TOTAL LIABILITIES
Total Liabilities
Assets Less Liabilities
Assets Less Liabilities
Income
INCOME
Spouse #1 Income
Spouse #2 Income
TOTAL INCOME
Total Income
Expenses
HOUSEHOLD
Mortgage/Rent
Cable and Cell
Telephone and Utilities
Other Household
FOOD/CLOTHING/TRANSPORTATION
Food Supplies
Clothing Supplies
Auto Loan Payments
Other Transportation Expenses
OTHER COMMITTED EXPENSES
Personal Care
Medical/Dental/Prescriptions
Medical Insurance
Other Loan Payments
Dependent Care/Child Care
Charge Card Payments
DISCRETIONARY EXPENSES
Entertainment and Dinner
Gifts
Miscellaneous
TOTAL EXPENSES
Total Expenses
Total Income Less Total Expenses
Total Income Less Total Expenses
Comments
Other Information (Optional)
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