Middlebury

INTERNATIONAL STUDENT FINANCIAL AID APPLICATION
Phone: 802.443.5158 Fax: 802.443.2065 email: sfs@middlebury.edu
Website: www.middlebury.edu/offices/support/sfs

DO NOT USE THE ENTER BUTTON WHILE TYPING DATA IN FORM. THIS WILL SUBMIT YOUR APPLICATION.



Last Name First Name MI
Social Security # Date of Birth
Country of Citizenship

   
Permanent Address:  
   Street Line 1
   Street Line 2
   Street Line 3
   City
   State
   Zip Code

Primary Phone:
Cell Phone:
E-mail:
    Can personal information be sent to this email address?    
E-mail is our main method of communication. Please be sure to update the Records Office with your most recent e-mail address and be sure to check your e-mail regularly, as we hold you responsible for the information we send you via email.

Marital Status (dependent students provide parents' status)
   Date of Separation/Divorce
   Other (explain if selected above)

Which program will you be enrolling in at Middlebury?    

Select Father or Stepfather if dependent, or Student if self-supporting    
    And provide the following if applicable    
      Name:
      Occupation:
      Employer:
Select Mother or Stepmother if dependent, or Spouse if applicable and self-supporting    
    And provide the following if applicable    
      Name:
      Occupation:
      Employer:


List Family Members:
   Include all members living with and supported by you or your parents. (If parents divorced, custodial parent only)
Full Name of Family Member
Age
Relationship to student
(student applicant)
 

How many dependents, including you, are in school or college?   
   Please provide the following information for dependents in school or college:
Name of Dependent
Name of School/College
Annual Cost to Attend Amount Provided by Family Amount of Institutional or
Governmental
Grant/Loan/Work
Attending
Next Year


List Total Annual Income (Provide Only Custodial Parents' Info If Dependent)
     (Enter in US Dollars, round to the next dollar)
   Source of Income
2015
2016
   Father's (if student is dependent)
   Mother's (if student is dependent)
   Yourself
   Spouse's
   Pension
   Interest/Dividends
   Rental Income
   Other

How much does your family plan to contribute towards your Middlebury education?   
What is the current exchange rate of your country's currency to the US dollar?
    (for example, 20 pesos = $1)
Do you have a source of emergency funds once you arrive in the US?   
     If Yes, what is the source?
     If Yes, what is the amount (in US$)?

Primary source of family income is from:   
    If "Other" selected, specify source:    

Do you or your family own a home?   
    If Yes, provide the following    (Enter in US Dollars, round to the next dollar)
       Year home was purchased:  
       Original purchase price:  
       How much is still owed:  
       What is the current value:  

Provide current value of other family assets.
   (Enter in US Dollars, round to the next dollar)
       Land and Buildings (other than home):  
       Savings - Parents:  
       Savings - Students:  
       Investments (such as stocks/bonds):  
       Money owed to your family by others:
        (Explain below)
       Other   (Explain below):  
         Explanations:  

Provide average amounts spent each year by your family for the following --
   (Enter in US Dollars, round to the next dollar)
       Food:  
       Clothing:  
       Housing (rent/mortgage):  
       Taxes:  
       Utilities:  
       Medical Expenses:  
       Other (Explain below):  
         Explanations:  

Do you or a member of your family own all or part of a business?  
    If Yes, provide the following information    (Enter in US Dollars, round to the next dollar)
      Date business was started:
      Percentage of business owned:  
      Number of employees:  
      Number of family members working for the business:  
      Type of business:  
      Describe products or service:  
      Gross revenues for current year:  
      Cost of sales:  
      Gross profit:  
      Operating expenses:  
      Net profit:  
      Wages paid to family members:  
      Current value of ALL business assets:  
      Total business debt:  
      Net business value:  

If your parents are divorced do you give us permission to share information   
about your aid decision with your non-custodial parent?  



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