C.V. Starr  Scholarship Program 2022   
  Family Financial Statement & Award Letter Summary  
     
  Check if this form is being completed by noncustodial parent
 
  Date
 
  Email that is checked regularly  
  Student Last Name
  Student First Name
       
  Parent 1:  First and last name/current age
  Parent 2:First and last name/current age
  Marital status of natural parents
 
  Please list names and ages of siblings in household  
  Sibling 1-Name/Age
  Sibling 2-Name/Age
  Sibling 3-Name/Age
  Number of full time students in college in 2022-23
 
  Estimated student income during summer 2022
  Student's current savings/investments (not 529s)
  Year/Make/Model of Student Vehicle
 
  Parent 1: Amount in Box 1 on 2021 Form W-2 
  Parent 1: Amount in Box 3 on 2021 Form W-2 
  Parent 2: Amount in Box 1 on 2021 Form W-2 
  Parent 2: Amount in Box 3 on 2021 Form W-2 
  Is either parent currently unemployed?
 
  Is either parent sel-employed?
 
  If yes, enter net business income for 2021 here
 
  Current savings and checking account value
  Non-retirement investment accounts
  529 & Coverdell college savings accounts
  If you rent your home, check this box
 
  Current market value of home
  Total  amount owed on home
  Current market value of any other real estate
  Total amount owed on other real estate
 
  Paying For College Next Year  
      Note - you will have a better idea of how to answer these questions AFTER completing the Award Letter Evaluation Form.  Click on that tab in upper left corner of page.    
  Amount you expect to spend on college from income in Year 1  
  Amount you expect to spend on college from savings Yr 1  
  Amount you expect to borrow for college Yr 1  
  Amount from student savings  Yr 1  
  Amount you expect to receive from others for college  
      Total resources available for Year 1    
      If selected, amount of CV Starr Scholarship you are requesting    
 
  Anything you would like to add?  Any special circumstances?  
   
   
   
   
   
   
  CV Starr 2022 Award Letter Summary        
  List up to eight colleges.  Please enter first choice college at top.    
                 
     
Name of College Total Cost of Attendance Grants & Scholarships Estimated VSAC Grant Student Loan: Subsidized Student Loan: Unsubsidized First Year Cost Available Resources Funding Gap
     
     
     
  Click Submit below to complete the process.  
     
  You will receive an acknowledgement and a copy of this form by email.  Thanks.