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.
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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