school and student services - international sudent t · student-applicant mailing address and phone...

SECTION A: APPLICANT INFORMATIONPlease print clearly in black ink.

Student applicant name

Last name (surname/family name) __________________________________________________________________________________

First name _________________________________________________________ Middle name ______________________________

Student date of birth _________________________

Student country of birth _________________________ Student country(ies) of citizenship _______________________________

Does the student currently hold a valid I-20? o Yes o No

If yes, from what school? _______________________________________________________________________________________

Current grade: o 8 o 9 o 10 o 11 o 12

Applying for grade: o 9 o 10 o 11 o 12 o post graduate

Current school _______________________________________________________________________________________________

School address _______________________________________________________________________________________________

Student-applicant home/permanent address:

_____________________________________________________________________________________________________________

_____________________________________________________________________________________________________________

Student-applicant mailing address and phone number (if different from above):

_____________________________________________________________________________________________________________

_____________________________________________________________________________________________________________

Valid phone number (include country and city codes) _________________________________________________________________

Student email address ___________________________________________________________________________________________

month/day/year

International StudentFinancial Aid Profile Please check with each school to see if this form is required as part of their financial aid application. If the school requires you to send this form to SSS, be sure to upload or mail it in addition to completing your PFS. Along with this form you must submit documentation as indicated in the Verification section on page 5.

Student applicant name ___________________________________________ Page 2 of 5

Section B: PARENT OR GUARDIAN INFORMATION

The student-applicant resides with: o Mother o Father o Stepmother o Stepfather o Grandparent

o Other (explain)_______________________________________________________________________________________________

Parents’ current marital status: o Married o Separated/Divorced o Other (explain) ____________________________________

Does any parent file a U.S. Federal tax return? o Yes o No

PARENT/GUARDIAN 1 NAME ______________________________________________________________________________

Age: _________ Relationship to student-applicant __________________________________________________________________

Email address _________________________________________________________________________________________________

Home address (if different from applicant) __________________________________________________________________________

_____________________________________________________________________________________________________________

Occupation/Title _____________________________________________________________________________________________

Employer ____________________________________________________________________________________________________

Number of years with employer ________ o Full time o Part time

PARENT/GUARDIAN 2 NAME ______________________________________________________________________________

Age: _________ Relationship to student-applicant __________________________________________________________________

Email address__________________________________________________________________________________________________

Home address (if different from applicant) __________________________________________________________________________

_____________________________________________________________________________________________________________

Occupation/Title _____________________________________________________________________________________________

Employer ____________________________________________________________________________________________________

Number of years with employer ________ o Full time o Part time

DEPENDENT INFORMATION How many people are dependent upon the family income for daily living expenses? _____________

List dependents in the household:

Name_________________________ Relationship to applicant____________________ Age______






(last, first, middle)

(last, first, middle)

Section C: FINANCIAL INFORMATION

What is the official exchange rate of your country’s currency to the U.S. dollar: _____________ = 1.00 USD

List your family’s annual income for the current calendar year and estimated for next year:

SOURCE OF INCOME THIS YEAR NEXT YEAR

Parent 1 salary/wages US$_______________ US$_______________

Parent 2 salary/wages US$_______________ US$_______________

Rental property income US$_______________ US$_______________

Business net income US$_______________ US$_______________

Interest or dividend income US$_______________ US$_______________

Pension/annuity/retirement income US$_______________ US$_______________

Income earned by student applicant US$_______________ US$_______________

Other income (please explain) US$_______________ US$_______________

ANNUAL EXPENSES THIS YEAR NEXT YEAR

Annual taxes paid to government US$_______________ US$_______________

Rent/mortgage US$_______________ US$_______________

Health insurance/medical US$_______________ US$_______________

Automobile US$_______________ US$_______________

Food US$_______________ US$_______________

Clothing US$_______________ US$_______________

Utilities US$_______________ US$_______________

Annual loan payments* US$_______________ US$_______________

Vacations US$_______________ US$_______________

Household help/maid/cook/nanny US$_______________ US$_______________

Other__________________ US$_______________ US$_______________

* Please indicate the nature and amount of the loan _______________________________________________________________

Does your family employ other people? o Yes o No

If yes, how many are employed? _________ In the home _________ In the family business _________


FAMILY ASSETS

HOME/RESIDENCE

Does your family own its own home? o Yes o No

Year of purchase ______________ Purchase price US$ ________________ Present value US$ ___________________

How much does your family still owe on the purchase price?_________________________________________________

Do you own any other property? o Yes o No If yes, please describe __________________________________

Year of purchase _______________ Purchase price US$ ________________ Present value US$ ___________________

Is either parent self-employed or holding an interest in a family business? o Yes o No

If yes, name of the business______________________________________________________________________________

Parent’s role in the business ______________________________________ % ownership __________________________

Total amount of current cash/savings US$ ____________________

OTHER ASSETS

Total amount of investments (stocks, bonds, etc.) US$ ____________________

Retirement savings US$ ____________________

Debts owed to family US$ ____________________

Assets owned by student-applicant US$ please describe _________________________________

______________________________________________________________________________________________________

Does your family have any money, property, or assets in another country? o Yes o No

Amount in US$ ________________ Country in which assets are held __________________________________________

Does your family receive income from these assets? o Yes o No If yes, US$ o _____________________________

EDUCATIONAL EXPENSESList all dependent children and educational expenses incurred for each:

Child’s Name Age School/University US$ Annual cost Amount paid by family

_____________________ ____ _____________________ _______________ ______________

_____________________ ____ _____________________ _______________ ______________

_____________________ ____ _____________________ _______________ ______________

How much can your family contribute toward all educational expenses next year? US$ ______________

How much can your family contribute toward the student applicant’s educational expenses?

US$ ______________


VERIFICATION

Documentation must be provided to verify this income information. (Note: All documents must be translated to English)

Please indicate which documentation you will send:

o Tax Returns o Proof of income o Other _______________________________________________________________

Statement of Truth:

I declare that the information reported on this form is, to the best of my knowledge and belief, true, correct, and complete.

We will contact each school if there is a change in our family’s circumstances.

PLEASE NOTE: Providing false information may jeopardize a student’s visa status and/or admission and financial aid status.

Signature of Parent/Guardian 1 ______________________________________________ Date _______________________

Signature of Parent/Guardian 2 ______________________________________________ Date _______________________


Last name surnamefamily name: First name: Middle name: Student date of birth: Student country of birth: Student countryies of citizenship: If yes from what school: Current school: School address: Studentapplicant homepermanent address 1: Studentapplicant homepermanent address 2: Studentapplicant mailing address and phone number if different from above 1: Studentapplicant mailing address and phone number if different from above 2: Valid phone number include country and city codes: Student email address: Student applicant name: o Other explain: o Married o SeparatedDivorced o Other explain: PARENTGUARDIAN 1 NAME: Age: Relationship to studentapplicant: Email address: Home address if different from applicant 1: Home address if different from applicant 2: OccupationTitle: Employer: Number of years with employer: Age_2: Relationship to studentapplicant_2: Email address_2: Home address if different from applicant 1_2: Home address if different from applicant 2_2: OccupationTitle_2: Employer_2: Number of years with employer_2: How many people are dependent upon the family income for daily living expenses: Name: Relationship to applicant: Age_3: Name_2: Relationship to applicant_2: Age_4: Name_3: Relationship to applicant_3: Age_5: Name_4: Relationship to applicant_4: Age_6: Name_5: Relationship to applicant_5: Age_7: Name_6: Relationship to applicant_6: Age_8: Student applicant name_2: What is the official exchange rate of your countrys currency to the US dollar: Other: US: US_2: US_3: US_4: US_5: US_6: US_7: US_8: US_9: US_10: US_11: US_12: US_13: US_14: US_15: US_16: US_17: US_18: US_19: US_20: US_21: US_22: US_23: US_24: US_25: US_26: US_27: US_28: US_29: US_30: US_31: US_32: US_33: US_34: US_35: US_36: US_37: US_38: Please indicate the nature and amount of the loan: In the home: If yes how many are employed: In the family business: Student applicant name_3: Year of purchase: Purchase price US: Present value US: How much does your family still owe on the purchase price: If yes please describe: Year of purchase_2: Purchase price US_2: Present value US_2: If yes name of the business: Parents role in the business: ownership: US_39: US_40: US_41: US_42: US please describe: Assets owned by studentapplicant: Amount in US: Country in which assets are held: Does your family receive income from these assets o Yes o No If yes US o: 1: 2: 3: 1_2: 2_2: 3_2: 1_3: 2_3: 3_3: 1_4: 2_4: 3_4: by family 1: by family 2: by family 3: How much can your family contribute toward all educational expenses next year US: US_43: Student applicant name_4: o Other: Date: Date_2: PARENTGUARDIAN 2 NAME: Check Box1: OffCheck Box2: OffCheck Box3: OffCheck Box4: OffCheck Box5: OffCheck Box8: OffCheck Box9: OffCheck Box10: OffCheck Box11: OffCheck Box12: OffCheck Box6: OffCheck Box7: OffCheck Box13: OffCheck Box14: OffCheck Box15: OffCheck Box16: OffCheck Box17: OffCheck Box18: OffCheck Box19: OffCheck Box20: OffCheck Box21: OffCheck Box22: OffCheck Box23: OffCheck Box24: OffCheck Box25: OffCheck Box26: OffCheck Box27: OffCheck Box28: OffCheck Box29: OffCheck Box30: OffCheck Box31: OffCheck Box32: OffCheck Box33: OffCheck Box34: OffCheck Box35: OffCheck Box36: OffCheck Box37: OffCheck Box38: OffCheck Box39: OffCheck Box40: OffCheck Box41: OffCheck Box42: OffCheck Box43: Yes

school and student services - international sudent t · student-applicant mailing address and phone...

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