Primary Contact Name
* Primary Contact Name
Primary Contact Email
Who else lives in your household besides the parents and children? Please include their name, relationship, and whether they are primarily supported by the parent(s).
How many of the people in the parent’s household will be in college during the period July 1, 2019 through June 30, 2020?
Please include anyone who will be enrolled at least half time in a program that leads to an undergraduate degree and include an estimate of the tuition, room, and board that parents will pay for this student.
Tax and Income Information
Please use your 2018 taxes to fill out the following section. If you do not have your 2018 taxes completed yet, you may fill out this section based on your 2017 taxes and any information you have about how those numbers may change for 2018. However, you agree to contact Pathfinder at your earliest convenience to update any differences of greater than $1,000 between what is listed on this form and your final 2018 taxes as filed.
List all sources of income and support not reported on your tax return.
Please write the source, amount, and frequency. Include actual amounts received in 2018, plus amounts anticipated in the 2019-20 school year. Examples include child support, gifts, Social Security benefits, SNAP benefits, untaxed unemployment income, wages or tips received in cash, railroad retirements benefits, etc. If you have no unreported income or support, write “NONE”.
Assets and Other Financial Information
Please fill out this section based on actual balances and amounts as of the date that you are filling out the form. You agree to contact Pathfinder at your earliest convenience if any of the answers to these questions change significantly.
As of today, what is the current value of your investments, including real estate? Don’t include the home in which you live.
Investments include real estate (do not include the home you live in), trust funds, UGMA and UTMA accounts, money market funds, mutual funds, certificates of deposit, stocks, stock options, bonds, other securities, installment and land sale contracts (including mortgages held), commodities, etc. Investments also include qualified educational benefits or education savings accounts (e.g., Coverdell savings accounts, 529 college savings plans and the refund value of 529 prepaid tuition plans), including all accounts in the name of the member, or in the name of the parents for any member of the household.
Investments do not include the home you live in, the value of life insurance, retirement plans (401[k] plans, pension funds, annuities, non-education IRAs, Keogh plans, etc.) or cash, savings, and checking accounts already reported.
Expenses and Other Financial Circumstances
Do you have expenses due to relocating or commuting in order to attend Pathfinder?
If so, please explain here, including the amount of expenses and how long you intend to incur them. Expenses could include double housing costs due to moving or commuting from more than 50 miles away, gas and transportation costs, or other costs. If you do not have these expenses, please write "NONE."
Do you have exceptional or unusual medical expenses?
If so, please explain here, including letting us know which family members have the expenses, what condition they have been diagnosed with, a detailed description of the various expenses, and the time over which you anticipate having to pay these expenses. Expenses may include diagnosis, appointments, treatment, surgeries, insurance, medical debt, modifications to one's home, etc. If you do not have these expenses, please write "NONE."
Please explain any additional exceptional or unusual expenses that you would like the committee to be aware of.
Providing as much detail as possible will help us.
Relationship with Pathfinder
Please describe your family's involvement in any circles or subcircles at Pathfinder.
Examples include Fundraising subcommittee and parent's circle.
What has participation in Pathfinder meant to your family?
If you are not yet members, please say something about why you are drawn to Pathfinder.
Pathfinder is committed to creating an inclusive community representative of the diverse population in the greater Durham area. Please note any way that you feel that your child and family will uniquely contribute to this goal. This could include heritage and culture, family structure, racial or gender identity, abilities, ethnicity, religion, etc
This question is optional.
Please describe any other ways that your family strengthens the Pathfinder community.
If you are not yet members, please describe how you hope to contribute to Pathfinder.
I declare that the information provided on this form and all attachments is correct and complete to the best of my knowledge and belief. I agree, if asked, to provide information that will verify the accuracy of the information provided on this form.
* I declare that the information provided on this form and all attachments is correct and complete to the best of my knowledge and belief. I agree, if asked, to provide information that will verify the accuracy of the information provided on this form.
Thank you! Your form will be reviewed by the Membership Fee Committee and you will be notified via email about their decision. All information submitted in this form will be kept strictly confidential.