CAP Assessment Form

Student Information

Please complete this form to the best of your ability. Providing accurate information will lead to a more realistic projection.

Parent Name

Student Name

State of Residence

Primary Contact Email Address

Family Information

Age of Oldest Parent

How many people live in the household, including parents?

How many people in the household, including the student will be in college during the 2022-2023 school year?

How many people in the household, not including the student, will be enrolled during the student's projected 4 year college degree?

Family Income and Assets

How much did the student earn in 2020?

How much did Parent 1 earn in 2020?

How much did Parent 2 earn in 2020?

Child Support received in 2020?

Amount of Untaxed Income in 2020 Tax Year?

Child Support Parents Paid in 2020 Tax Year?

Total Parents Cash, Checking and Savings Balance?

Total Student Cash, Checking and Savings Balance?

Total Student Investment Net Worth

If negative enter 0

Total Student Business / Farm Net Worth?

Applies to Businesses employing >100

Total Parent Investment Net Worth

If negative enter 0

Total Parent Business / Farm Net Worth?

Applies to Businesses employing >100

Family Financial Goals for 2022

In this section we are looking to get a better understanding of your financial goals for the upcoming year. For each of these questions we would like you to enter the amount that your familiy would like to contribute to each of the categories to gain financal secruity. If you do not have any goals or do not contribute to these areas, you may enter 0.

How much do you anticipate you will contribute monthly to your savings?

How much would you like to save in 2022

How much do you anticipate you will contribute to your retirement monthly? Please enter as a dollar amount.

How much do you antipate you will invest monthly in 2022?

Family investments in equities, real estate etc., this year

How much do you anticipate you will contribute monthly to a college saving plan or account?

Family Expenses

Please provide your monthly family expenses. This will help give us a better sense of the expenses you have going out each month. Please anser these questions based on the entire household rather than an individual.

Monthly Car Payments?

Includes Auto Lease and Loan Payments.

Monthly Housing Costs

Includes Mortgage and Rent Payments.

Monthly Insurance Premiums?

Includes Medical, Home, Renters, Auto and Life Insurance, etc.

Monthly Debt Payments?

Monthly Food Expenditure?

Includes grocery, restaurants, delivery, take out and warehouse memberships.

Monthly Utilities Expenditure?

Includes electricity, water, heating fuel, cell phone plans, Wi-Fi , satellite or cable connectivity and any subscription service (NETFLIX, AppleTV, etc.)

Monthly Transportation Expenditure?

Includes gasoline, road tolls, ride-shares, public transportation, parking, snow removal, licensing, registration and car maintenance.

Monthly Care/Tuition Expenditure?

Includes Daycare, Eldercare, School or Course Work, Tuition and fees.

Monthly Entertainment and Vacation Expenditures