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INTERNATIONAL STUDENT FINANCIAL AID APPLICATION
Phone: (802) 443-5158 Fax: (802) 443-2065 email: studentfinancialservices@middlebury.edu
Website: http://www.middlebury.edu/offices/support/sfs.

PLEASE DO NOT USE THE ENTER BUTTON. THIS WILL SUBMIT YOUR APPLICATION.

STUDENT INFORMATION MIDDLEBURY ID#
Last Name First Name Middle Name

Date of Birth:

Street Line 1 Social Security #
Street Line 2
Street Line 3
City State Zip Code Country of Citizenship
 
E-mail: Phone: Fax:
Marital Status (dependent students provide parents? status)
  Date of Separation/Divorce (provide only custodial parent?s info on this form if dependent)
  Other(explain if selected for Marital Status above)
Can personal information be sent to this e-mail address?
Can personal information be sent to your fax number?
Program You Are Applying For:
 
Name:
Occupation:
Employer:
 
Name:
Occupation:
Employer:
List all family members living with and supported by you or your parents. (If parents are divorced, custodial parent only)
NAME RELATIONSHIP AGE NAME RELATIONSHIP AGE
How many dependents including you are in school or college?
Please list below:
NAME NAME OF
SCHOOL/COLLEGE
ANNUAL COST TO
ATTEND
AMOUNT
PROVIDED BY
FAMILY
AMOUNTS OF
INSTITUTIONAL OR
GOVERNMENTAL
GRANT/LOAN/WORK
ATTEND
NEXT YEAR
List Total Annual Income(provide only custodial parent?s info on this form if dependent)
Source of Income 2013 2014
Father's (if student is dependent)
Mother's (if student is dependent)
Yourself
Spouse's
Pension
Interest/Dividends
Rental Income
Other
TOTAL
How much does your family plan to contribute towards your Middlebury education?
What is the present exchange rate of your country's currency to the US$ (for example, 20 pesos=$1)?
Do you have a source for emergency funds once you arrive in the U.S.?
    If yes, name source
    Amount in US$
The primary source of family income is from
    If "other", specify source:
Do you or your family own a home? (If yes, complete below)
    a) What was the year it was purchased?
    b) What was the original purchase price? US$
    c) How much do you or your family still owe on the purchase price? US$
    d) What is the present sale value? US$

Information Give present value of other family assets:

 
a. Land and buildings (other than home) US$
b. Savings: Parents US$
c. Savings: Students US$
d. Investments (such as stocks and bonds) US$
e. Money owed to your family by others (Explain below) US$
f. Other (Explain below) US$
TOTAL US$
EXPLAIN

Information Give average amounts of money spent each year by your family for:

 
a. Food US$
b. Clothing US$
c. Housing (rent or mortgage payments) US$
d. Taxes US$
e. Utilities US$
f. Medical Expenses US$
g. Other (explain below) US$
TOTAL US$
EXPLAIN
Do you or a member of your family own all or part of a business? (If yes, complete below)
Date Business Started: Cost of Sales: US$
Percentage of business owned: Gross Profit: US$
Number of employees: Operating Expenses: US$
How many family members work in the business? Net Profit: US$
Type of business: Wages paid to family members: US$
Describe products or services: Current Value of ALL Business Assets: US$
Gross Revenues for current year: US$ Total Business Debt: US$
Net Business Value: US$
If your parents are divorced or separated do you give us permission to share information about your aid decision with your non-custodial parent?


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Release: 8.19