In Christo Omnia Nova

2017-2018 Providence Christian College International Financial Aid Form

SECTION A – STUDENT INFORMATION

Name: ______

Family First/Given Middle

Permanent address ______

Number Street City Province Postal Code

Telephone (______) ______Email Address______

Date of Birth (MM/DD/YYYY) ______Gender: Female Male

Place of Birth______Country of Citizenship______

Present marital status: Married Unmarried

Year in College during 2017-2018: 1st 2nd 3rd 4th 5th (undergrad)

When do you expect to graduate or complete your program at Providence? ______

Have you or do you plan to file for a Canadian Student Loan through your Province? Yes No

SECTION B – STUDENT’S STATUS

Was the student born BEFORE January 1, 1994? □ Yes □ No

Is the student an orphan or ward of the court? □ Yes □ No

Is the student currently married? □ Yes □ No

Does the student have dependents other than spouse? □ Yes □ No

SECTION C – FAMILY INFORMATION

Father (Stepfather) Mother (Stepmother)

Name ______Name ______

Occupation ______Occupation ______

Employer______Employer______

Birthdate ______Birthdate______

Parent’s current marital status is: single married separated divorced widowed (circle)

Total size of the parent’s household during 2017-2018 will be (Include yourself and your parents. Include your parents’ other children if they now live with and get more than half their support from your parents.) ______

Of those in parent’s household how many will be in college at least half-time during 2017-2018______

Other family members – list below and give information for all other family members. Do not include parents or the student for whom for this form is being completed.

Name / Age / Relationship to you / Name of school or college this person will attend in 2017-2018 / Year in School
2017-2018

SECTION D – FINANCIAL INFORMATION

Do you have a source of emergency funds once you arrive in the U.S.? Yes No

If yes, name source and available U.S. dollars______

How will you pay for your transportation to the U.S.?______

Please complete the parent and student income and asset information using actual amounts for 2016 and projected amounts for 2017. (List all amounts in U.S. dollars)

Student Income Information / 2016 / 2017
1. Students income from work
2. Spouse’s income from work (if applicable)
3. Interest and dividends
4. Other income – explain:
Total
Parent Income Information
1. Father’s income from work
2. Mother’s income from work
3. Interest and dividends
4. Rental income
5. Business income
6. Other income – explain:
Total
Asset Information
1. Parent’s cash, savings, and checking
2. Parent’s investments
3. a. Value of home
b. Debt on home
4. a. Value of business
b. Debt on business
5. a. Value of land/buildings
b. Debt on land/buildings
6. Student’s cash, savings, and checking
7. Student’s investments
8. Other – explain:

SECTION E – OUTSIDE FINANCIAL AID

I expect to receive financial assistance / scholarships from other public or private sources (e.g. high school awards, civic organizations awards, public company awards, church grants, etc.). List the source(s) and the amount(s) you expect to receive below:

Source of Outside Aid / Fall Semester $ / Spring Semester $

SECTION F – EXPLANATIONS/SPECIAL CIRCUMSTANCES

Use this section to explain any unusual circumstances. These may include things such as: divorce, separation, death of parent(s), unemployment for extended period, anticipated significant loss of income in 2017, excessive medical expenses/health problems, or any other unusual circumstance.

I/We declare that the information on this form is true, correct, and complete. Providence Christian College has my/our permission to verify the information reported.

______

Signature of Student Date

______

Signature of parent, sponsor, or guardian (if dependent student) Date

Return form to: Providence Christian College Toll-free: 866.323.0233

Attn: Financial Aid Office Fax: 626-696-4040

1539 E. Howard Street Scan-email to:

Pasadena, CA 91104 www.providencecc.edu