Aid Application

Financial Aid Application

Instructions

This application should be completed by the student and his/her parents or sponsor. Answer all questions. Use United States dollars when responding to questions about funding.

Student Information

Student's name _______________________________________________Citizenship___________________________________
Mailing address __________________________________________________________________________________________
________________________________________________________________________________________________________
Permanent address (if different from above) _____________________________________________________________________
________________________________________________________________________________________________________
Telephone ________________________________Fax _________________________________Email______________________

Family Information

Father's full name _________________________________________________________If deceased, please check _____________
Mother's full name ________________________________________________________If deceased, please check _____________
Parents' marital status _____ Married, living together; _____ Separated/Divorced; _____ Other, (explain) ____________________
List children in the family by : name, age, school they attend________________________________________________________
_________________________________________________________________________________________________________

Father's Employment Information
Company's name _______________________________
Employer's WWW address ________________________
Employer's fax number __________________________
Father's position ________________________________
Years of employment with company ________________

Mother's Employment Information
Employer's name _________________________________
Employer's WWW address ___________________________
Employer's fax number ____________________________
Mother's position:__________________________________
Years of employment with company __________________

Income Report

Father's Income
Annual income (before taxes)

Bonus and/or commissions

Interest income

Net income from business,farm, rents, royalties, estates,trusts, etc.

Other income

Total

US dollars

$_________________

$_________________

Mother's Income
Annual income (before taxes)

Bonus and/or commissions

Interest income

Net income from business,farm, rents, royalties, estates,trusts, etc.

Other income

Total

US dollars
$_________________

$_________________

Father's Benefits Provided by Employer
List equivalent value in US dollars

Free housing _____________________________________
Housing supplement________________________________
Use of automobile __________________________________
Stock in company __________________________________
Partial or full tuition plans ___________________________

Mother's Benefits Provided by Employer
List equivalent value in US dollars

Assets

Family Assets

Cash, checking, and savings accounts

Stocks, bonds, trusts

Business, farm (total value)

Real estate

Net income from business, farm, rents, royalties, estates, trusts, etc.

Other income

Total

US dollars

$_________________

Scholarships, Grants, Loans:

List any government agencies, foundations and all other sources to which you are applying for financial aid. This includes travel awards and gifts from friends and relatives.

Name of scholarship _______________________
Organization ______________________________________
Amount to be awarded _______________________________
Date applied/received _______________________

Name of scholarship ____________________
Organization ___________________________________
Amount to be awarded ___________________________
Date applied/received ___________________________

Exchange Rate/Restrictions:

List the present exchange rate of your country's currency to United States dollars.
(For example: 20.5 pesos = US $1.00).

Currency name: _________________ Country____________________________ Rate: ___________ = US $1.00.

Describe any government restrictions on exchange and release of funds for study abroad.

Brief description of your family's financial situation:

In the space below, please describe your family's financial situation and any circumstances that Lewis & Clark should consider in judging the amount of funds, if any, you should be awarded. You may attach a separate sheet.

Summary of Funds Available:

Enter the source of funding you will recieve from each source below.

Your parents:

Relatives and friends

Your savings

Scholarship, grant, loan

Other

Total Amount:

Academic year
August - May

$_________________

Number of years the amount
is expected

_________________

Required Documents to Accompany this Form

A letter from your parents' or sponsor's employer, stating position, salary, all benefits and years of service.
A letter from a bank stating the amount of funds available to the parents, student or sponsor.
A copy of the most recent tax forms from the country where you or your parents pay taxes.
A copy of an award letter of any scholarships or loans that you receive.

Certification

For Parents/Sponsor: I certify that I will be responsible for all expenses, as indicated above, of my son/daughter during his/her studies at Lewis & Clark College. I also certify that all of the information on this form is complete, factually correct, and honestly presented.

Signature of parent/sponsor
___________________________________

Date ______________________________

For the student: I certify that all of the information on this form is complete, factually correct, and honestly presented.

Signature of student
___________________________________

Date ______________________________

Send this form, along with accompanying documents, by mail or by fax to:

International Students and Scholars
MSC 192
Lewis & Clark College
0615 SW Palatine Hill Road
Portland, Oregon 97219-7899
USA
Fax: 503-768-7301

Deadline: February 1