Application for Financial Assistance

2015/2016Academic Year

Please read and review the form and the instructions carefully before you fill it in and do not leave any boxes blank.

PLEASE PRINT IN BLOCK LETTERS

I. APPLICANT’S PERSONAL PROFILE

1Name: ______

LastFirstMiddle

2Gender:MaleFemale

3Date of birth: ______/______/______

Month Day Year

4Intended date of admission: Fall’13Spring’14

5Nationality: ______

6 Country of residence: ______

7 City: ______

II. FAMILY INFORMATION

8 In answering the following question, please refer to your biological parents

8aParents’ current marital status (check only one box):

Married Divorced Mother living, father deceased Father living, mother deceased

Parents not married Domestic Partnership Other______

(Please specify)

9 In the definition of family below, use the current family members (step-parents, if needed)

10How many persons, including the applicant, are dependent upon the family income?

(i) Relationship to applicant(ii) Age

10aIncome earner A. ______

10bIncome earner B. ______

10cIncome earner C. ______

10dOther Member D. ______

10e Other Member E. ______

10fOther Member F. ______

11List any dependents who are in school or university:

11aName: ______Name of school/university: ______

Annual cost to attend: ______Family contribution: ______Inst.grant/loan/work:______

11bName: ______Name of school/university: ______

Annual cost to attend: ______Family contribution: ______Inst.grant/loan/work:______

11cName: ______Name of school/university: ______

Annual cost to attend: ______Family contribution: ______Inst.grant/loan/work:______

12Does yourfamily own or rent your primary residence:

OwnRent Live with others

III. EMPLOYMENT INFORMATION OF INCOME EARNERS LISTED IN PART II ABOVE

13INCOME EARNER A: ______

LastFirstMiddle

13aOccupation: ______

13bName of Employer: ______

13cStreet address: ______

13dCity: ______

13eState: ______

13fPostal code: ______

13gCountry: ______

13hTelephone: (______)______

14INCOME EARNER B: ______

LastFirstMiddle

14aOccupation: ______

14bName of Employer: ______

14cStreet address: ______

14dCity: ______

14eState: ______

14fPostal code: ______

14gCountry: ______

14hTelephone: (______)______

15INCOME EARNER C: ______

LastFirstMiddle

15a Occupation: ______

15b Name of Employer: ______

15c Street address: ______

15dCity: ______

15eState: ______

15f Postal code: ______

15g Country: ______

15h Telephone: (______)______

16Additional information concerning employment: ______

______

______

______

______

______(Attach additional sheets if necessary)

IV. INCOME FROM EMPLOYMENT IN NATIONAL CURRENCY

(For the most recent 12-month period)

(i) Gross income (ii) Income tax paid (iii) Net Income

17Father:______

18Mother:______

19Student:______

20Spouse: ______

21Other (step-parent): ______

22Total: ______

V. INCOME FROM PRIVATE BUSINESS

(For the past tax year. If more than one business, add the results of all businesses)

(i) Revenue(ii) Expenses (iii) Profit (loss) (iv) Number of

employees

23Father:______

24Mother:______

25Student:______

26Spouse: ______

27Other (step-parent): ______

28Total: ______

29Type of private business (explanation/additional information for lines 23-28): ______

______

______

______

______

______

VI. OTHER INCOME

(i)Pensions (ii) Unemployment(iii) Alimony (iv) Social security

compensations received benefits

30Father:______

31Mother:______

32Student:______

33Spouse ______

34Other (step-parent):______

35Total: ______

VII. TOTAL NET FAMILY INCOME

36Total net family income (add lines 22, 28, 35):______

VIII. ASSETS

Current savings (from bank accounts)

37Father:______

38Mother:______

39Student:______

40Spouse: ______

41Other (step-parent): ______

42Total:______

IX. OTHER ASSETS

43Please provide a list of homes, apartments and land owned by members of your immediate family:

43aOwner: ______

Home / Apartment / Land: ______

Address: ______

City: ______State: ______

Postal code: ______Country: ______

43bOwner: ______

Home / Apartment / Land: ______

Address: ______

City: ______State: ______

Postal code: ______Country: ______

43cOwner: ______

Home / Apartment / Land: ______

Address: ______

City: ______State: ______

Postal code: ______Country: ______

44Please provide a list of the automobiles owned by those living in your household:

44aMake: ______Model: ______Year: ______License Number: ______

44b Make: ______Model: ______Year: ______License Number: ______

44cMake: ______Model: ______Year: ______License Number: ______

44dMake: ______Model: ______Year: ______License Number: ______

X. TRAVEL INFORMATION

45Please provide a list of countries you have visited and the purposes of the trip:

45a Country: ______Purpose: ______Date of trip: ______

45b Country: ______Purpose: ______Date of trip: ______

45c Country: ______Purpose: ______Date of trip: ______

45d Country: ______Purpose: ______Date of trip: ______

45e Country: ______Purpose: ______Date of trip: ______

45f Country: ______Purpose: ______Date of trip: ______

45gCountry: ______Purpose: ______Date of trip: ______

XI. EXPECTED AMOUNT OF FINANCIAL CONTRIBUTION TOWARDYOUR EDUCATIONAL EXPENSES DURING THE NEXT ACADEMIC YEAR

(Please estimate in US dollars using the current exchange rate.)

46Immediate family: $______

47 Scholarships (other than AUBG): $______

48 Other relatives and friends: $______

49 Private sponsors: $______

50Student’s vacation earnings: $______

51 Other: $______

52Total Financial Contribution: $______

XII. COMMENTS / EXPLANATORY NOTES

53Use the space below to add any comments or explanations regarding the contributions noted above.

Also mention any special circumstances you think we should consider in determining the amount ofassistance you might need. Include Information and documentation on outstanding loans, mortgages, and rent paid.

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(Attach additional pages, if necessary)
54Checklist of required documents to include with this form: All documents must be in English or Bulgarian. All documents enclosed become the property of AUBG and will not be returned. Missing documents invalidate the application for financial assistance.

Mother / Father / Applicant & other member(s) of the family
Documents Enclosed / Yes / NA / Yes / NA / Yes / NA
a. / Gross and net income with monthly distribution up to date of application. / □ / □ / □ / □ / □ / □
b. / Copies of the Annual Tax Declarations for last year’s taxable income. / □ / □ / □ / □ / □ / □
c. / Certificate proving absence of trade activities issued by the respective Tax Authorities. / □ / □ / □ / □ / □ / □
d. / Certificates for family savings issued by the bank. / □ / □ / □ / □ / □ / □
e. / Certificates from the Bureau of Labor for the unemployed members of the family indicating the amount of unemployment compensation received. / □ / □ / □ / □ / □ / □
f. / Certificates for pensions including the amount received. / □ / □ / □ / □ / □ / □
g. / Copies of courts decisions in case of divorced parents. / □ / □ / □ / □ / □ / □
h. / Alimony certificates, if applicable / □ / □ / □ / □ / □ / □
i. / Copies of death certificate(s) in case of deceased parent(s). / □ / □ / □ / □ / □ / □
j. / Certificates for medical disability or medical problems,if applicable. / □ / □ / □ / □ / □ / □
k. / Registration documents for all vehicles owned by members of the family or private business owned by family members. / □ / □ / □ / □ / □ / □
l. / Certificates of ownership for all property (homes, apartment or land) owned by family members. / □ / □ / □ / □ / □ / □

XII. APPLICANT’S DECLARATION

I HAVE READ AND UNDERSTAND THE INSTRUCTIONS FOR THIS FORM. To the best of my knowledge, the information provided in this application is complete and correct. I understand that applications for financial aid that are incomplete or missing required documents are invalid. I understand that once this application is filed, I do not have the opportunity to submit additional documents or new applications for financial assistance for the current year.

Signature of student:: ______Date: ______

Signature of parent or guardian: ______Date: ______

Please send the completed form to: Admissions Office

AmericanUniversity in Bulgaria

54 Aleksandar Stamboliiski Str.

Blagoevgrad 2700, Bulgaria

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