FINANCIAL STATEMENT AND PERSONAL BALANCE SHEET
ASSETS Checking Accts. $ Savings Accts. $
LIABILITIES Total School Loans to date $ Total Mortgages $ Auto Loans $ Total Credit Cards $
Stocks & Bonds $ Other Real Estate and Investments $ Automobiles (Market Value) $ Personal Residence (Market Value) $ (Equity Value) Retirement IRA or 401K Cash Value Life Insurance Other Assets $
Other Loans $ Other Liabilities: (Itemize) $ $ $
$ $ $ $ TOTAL LIABILITIES: $ NET WORTH: $ $
TOTAL ASSETS: $
CURRENT ANNUAL SALARY OF APPLICANT CURRENT ANNUAL SALARY OF SPOUSE (IF APPLICABLE) ARE YOU (OR YOUR CHILDREN) RECEIVING ANY OTHER FINANCIAL ASSISTANCE OF ANY KIND CHILD SUPPORT, S.S. BENEFITS, ETC? IF SO, STATE AMOUNTS:
PLEASE ENCLOSE COPY(S) OF MOST RECENT TAX RETURN(S).
The above information and statements are correct and true to the best of my knowledge and belief. I hereby authorize the Cincinnati Catholic Women Continue with Confidence Scholarship Committee to verify the enclosed Financial Statement and Personal Balance Sheet with my employer or any other source deemed necessary.
Signature of Applicant
Date