Supplemental Data Form 2017-18

This form is used to apply for financial aid at Dordt College and to supplement the information provided on the Free Application for Federal Student Aid (FAFSA). Please click here to read the full instructions for completing this form and to access the printable Supplemental Data Form (if that is your preference).

Section A: General Information—Must be completed by ALL applicants

Student Identification

First Name:
Middle Name:
Last Name:
Permanent Address:

Zip Code:
Year in College in 2017-18:
US Citizen?

If not, are you a permanent resident?
Dual Citizen?

If yes, what countries?
State of Legal Residence:
Do You Have Transportation?

Have You Ever Attended Another College?

If yes, please list name, city, state, and dates attended:
Church Name and Denomination:
High School Attended:

List 2016 Employment--Employer and Description of Position:

Have you applied or will you apply to any other college for 2017-18?

If yes, other college(s) applied to:

Will You Be a Commuter?

Financial Aid Information

Do you intend to be a full-time student?

Have you completed the Free Application for Federal Student Aid (FAFSA) or the online Renewal Application?

If yes, when did you submit it?

List below any outside scholarships, grants, bursaries, loans or other assistance (including dollar amounts) that you expect to receive for the 2017-18 school year. It is not necessary to list any aid from Dordt College; only outside sources:

Did you have a job on campus last year?

If yes, please list:

Section B: Parents' Information—For all DEPENDENT students


Did either parent attend Dordt for one full year or more and successfully complete at least 24 credits?

If yes, who?

Give information for all dependent children and other dependents for 2017-18 (those included in the FAFSA):

Name and Relationship (e.g. brother, sister) Age Name of school or college this person will attend in 2017-18 school year Year in school 2017-18 If attended college in 2016-17, give amount of:
2016-17 Scholarships or Grants 2016-17 Parents' Contribution

*If more than 6 dependents, list additional family members under Other Special Circumstances.

Will either parent be attending college at least half-time in 2017-18?

If yes, please list name, city, and state of college:

Divorced/Separated Parents (completed by the parent who files this form):

Is there an agreement specifying a contribution for the student's education?

If yes, how much per year? $

Parents' Assets:

Do parents own a home?

Value of home today: $

Debt on home today: $

Do parents own a farm?

Value of farm today: $

Debt on farm today: $

Include a family farm which is your principal place of residence and source of revenue. Such farms are NOT to be reported on the FAFSA #89.

Do parents own a small business?

Value of business today: $

Debt of business today: $

Include a small family business which you own and control and that has 100 or fewer employees. Such businesses are NOT to be reported on the FAFSA #89.

Parents' 2017 Expected Income:

2017 income earned from work by father: $

2017 income earned from work by mother: $

Section C: Request for Consideration of Special Circumstances

When this form is processed, formulas will be applied which assess how much the parents can contribute and how much the student can contribute. This effective family contribution will be based on parents' and student's income and assets with standard allowances made for other necessary expenses.

Sometimes families have special circumstances which substantially affect their ability to contribute towards educational expenses. Two of the most common special circumstances at Dordt College are tuition paid for other family members at elementary or high schools, and excessive medical/dental expenses. Occasionally other factors may affect the family's contribution, such as: a significant reduction in parental income for the upcoming year, other non-discretionary expenses not mentioned on the form, a higher cost of living than the national average, a significant debt not reported on the form, or a natural disaster. (Special circumstances refer to something unique to your family.)

If you would like to request consideration for special circumstances, please complete the appropriate items below.

Tuition for other children. Indicate the total tuition paid in 2016-17 for children in kindergarten through grade 12: $

Medical/dental expenses not covered by insurance. An allowance will be considered for medical/dental expenses paid in 2016 if, including insurance premiums, they exceed 7.5% of income (Form 1040, Schedule A, line 1): $

Other Special Circumstances--please itemize giving specific dollar amounts and explain in paragraph form any unusual situations:

By completing the box/boxes below and submitting this form I/we certify that all information is correct and complete:

Student's signature/certification
Parent's signature/certification

Human, leave this blank