Financial Statement

Statement of Income and Expense:

This statement is only to be completed if you are not eligible to apply for Federal Financial Aid. You must complete and submit this form to be considered for all need-based private scholarships. The deadline is March 1st.

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Applicant's Full Legal Name:*

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Banner ID:

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E-mail:*

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Permanent Street Address:*

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Country:

Afghanistan Albania Algeria Andorra Angola Antigua and Barbuda Argentina Armenia Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bhutan Bolivia Bosnia and Herzegovina Botswana Brazil Brunei Bulgaria Burkina Faso Burma Burundi Cambodia Cameroon Canada Cape Verde Central African Republic Chad Chile China Colombia Comoros Congo (Brazzaville) Congo (Kinshasa) Costa Rica Cote d"Ivoire Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Fiji Finland France Gabon Gambia Georgia Germany Ghana Greece Grenada Guatemala Guinea Guinea-Bissau Guyana Haiti Honduras Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati North Korea South Korea Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Mauritania Mauritius Mexico Federated States of Micronesia Moldova Monaco Mongolia Montenegro Morocco Mozambique Namibia Nauru Nepal Netherlands New Zealand Nicaragua Niger Nigeria Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Poland Portugal Qatar Romania Russia Rwanda Saint Kitts & Nevis Saint Lucia Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa Spain Sri Lanka Sudan Suriname Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Togo Tonga Trinidad & Tobago Tunisia Turkey Turkmenistan Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States Uruguay Uzbekistan Vanuatu Venezuela Vietnam Yemen Zambia Zimbabwe

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Phone Number:*

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Monthly Income:

Monthly/Salary of Applicant

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Salary of Spouse (if married):

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Child support/alimony:

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Parent Monthly Contribution:

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Welfare assistance/food stamps:

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All Other Monthly Income (add all together):

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Total Monthly Income:

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Additional Information:

Total in Savings Accounts:

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Total in Checking Accounts:

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Total in Investments:

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Scholarships You are Receiving:

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Educational Expenses Per Semester:

Tuition:

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Student Fees:

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Transportation (to/from class):

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Books/Educational Supplies:

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Childcare (related to education):

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Housing:

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Other Educational Expenses:

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Total Education Expenses Per Semester:

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Number of Months per Term:

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Monthly Educational Expense: (Divide total educational expenses amount by number of months in each term.)

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Personal Monthly Expenses:

Personal Monthly Rent/mortgage payment:

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Medical/Dental:

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Food/Groceries:

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Automobile Payment:

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Utilities:

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Automobile Insurance:

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Telephone:

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Insurance (home, health, life, etc.):

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Personal Expenses (clothing, activities...):

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Loan/Charge Payments:

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Childcare (not education related):

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Other Educational Expenses:

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Other Educational Expenses:

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Other Educational Expenses:

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Total Personal Monthly Expense: (add monthly expenses above)

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Total Monthly Educational and Personal Expense Combined

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Applicant's Name:*

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Date:

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By submitting this form online, you are certifying that the information provided is accurate to the best of your knowledge.

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