Gold Medal Swim Club Financial Scholarship Form

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

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

Comments

Other Information (Optional)

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Gold Medal Swim Club Financial Scholarship Form