______________________________________________________________________________________
Last Name First MI SS#
______________________________________________________________________________________
Street Address (Permanent)
______________________________________________________________________________________
City State Zip Code
___(______)____________________________________________________________________________
Phone Email
______________________________________________________________________________________
University
Directions: To be completed by Financial Aid officer if applicable.
Do you plan to apply for any type of financial student aid for the fall 2002 semester?
________ Yes _______ No
If the answer is "yes", please visit this web site to apply.
Please itemize each of the following costs incurred at home university
per
semester and Financial Assistance
student receives towards each.
Please attach a copy of student spring 2002 university billing
statement.
TUITION
| 2002 Semester Tuition Rate | $ |
| Financial Assistance you receive towards tuition | (per semester) |
| Name of Scholarship | |
| 1. | $ |
| 2. | $ |
| 3. | $ |
| Name of Grant | |
| 1. | $ |
| 2. | $ |
| 3. | $ |
| Other | |
| 1. | $ |
| 2. | $ |
| 3. | $ |
ROOM AND BOARD
| 2002 Semester Room cost | $ |
| Financial Assistance you receive towards room (per semester) | $ |
| 2002 Semester Meal Cost | $ |
| Financial Assistance you receive towards meals (per semester): | $ |
| You live at home and do not incur room and board expenses | ____ Yes |
FEES
| Total of all mandatory fees | $ |
| Financial Assistance you receive towards fees | $ |
| Name of Mandatory Fees | |
| 1. | $ |
| 2. | $ |
| 3. | $ |
| 4. | $ |
| 5. | $ |
OTHER EXPENSES
| 1. | $ |
| 2. | $ |
| 3. | $ |
Please complete Financial Aid Officer information, if applicable:
______________________________________________________________________________________
Last Name First MI
______________________________________________________________________________________
Street Address
______________________________________________________________________________________
City State Zip Code
___(______)____________________________________________________________________________
Phone Email
________________________________________________________________________
Signature
Date
________________________________________________________________________
Student Signature Date