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Supplemental Financial Data Form: Kulkarni Ritvik Black at Microsoft 555 Sterling Brook Drive Lexington SC 29072 US

The Supplemental Financial Data Form is required if the applicant's parents or spouse cannot submit data jointly. It includes sections for student information, family financial information, and certification signatures, detailing income, expenses, and household composition. The form must be uploaded with other supporting documents before application submission.

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3 views1 page

Supplemental Financial Data Form: Kulkarni Ritvik Black at Microsoft 555 Sterling Brook Drive Lexington SC 29072 US

The Supplemental Financial Data Form is required if the applicant's parents or spouse cannot submit data jointly. It includes sections for student information, family financial information, and certification signatures, detailing income, expenses, and household composition. The form must be uploaded with other supporting documents before application submission.

Uploaded by

rpeonmvay
Copyright
© All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

Supplemental Financial Data Form

This form is needed only if applicant’s parents/applicant’s spouse cannot submit data jointly on the electronic application.
If applicable, this form is to be uploaded along with the other supporting documents prior to application submission.

A. STUDENT INFORMATION

Last name Kulkarni First name Ritvik Application ID#

Program Name Black @ Microsoft

Permanent mailing address 555 Sterling Brook Drive

City Lexington State/Province SC ZIP/Postal code 29072 Country US

B. FAMILY FINANCIAL INFORMATION

The applicant’s parent/guardian(s) or Spouse (if applicable) must complete the following section.

1. State/Province of Residence ……….………. SC 6. Medical and Dental Expenses not paid


by insurance (exclude premiums) ..………………...$ 0
2. Adjusted Gross Income (FORM 1040) ……… $ 154000
7. Total Cash, Checking, Savings, and Cash Value of
3. Total Federal Tax Paid (FORM 1040) ………. $ 13443 Stocks (exclude retirement plan funds, IRA, 401k) $ 20,000
(Not the amount withheld from paychecks)
8. Total number of family members living in the household
4. Total Income of Parent/Spouse.……………… $ 154003 and primarily supported by the reported income …# 4

Total Income of Stepparent (if applicable)…. $ 9. Marital status of parent or guardian (if applicable):
 Married  Divorced  Separated  Widowed  Single
5. (U.S. Only) Yearly Untaxed Income and Benefits:
Please indicate source – 10. Of the total number of family members on line 8, number of
 Social Security  Child Support students attending college at least half-time during the next
 Other ____________________ ….……… $ school year (include applicant, exclude parents) …# 1

C. CERTIFICATION AND SIGNATURES

Ritvik Kulkarni
Certification: All information provided is complete and Applicant’s Signature
accurate to the best of my (our) knowledge. If
requested, I (we) will provide proof of information Apeksha Kulkarni
including a copy of my (our) most recently filed income Parent’s/Spouses Signature
tax return. Falsification of information or refusal to
provide information may result in rejection of this
application or termination of any award granted. Do you have legal custody of applicant?  Yes  No
Is applicant your dependent?  Yes  No

Date Completed March 16th, 2026

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