American University in Kyrgyzstan

1. Full name

LAST NAMEFIRST NAMEPATRONYMIC/MIDDLE NAME

2. Current address

COUNTRY REGION

______

CITY ADDRESS (STREET AND NUMBER)

Phone number: (______) ______; Cell phone number: (______) ______;

E-mail:

2a. Permanent address

COUNTRY REGION

______

CITY ADDRESS (STREET AND NUMBER)

Phone number: (______) ______;

3. Country of citizenship: ______

4. Passport data

NUMBERDATE OF ISSUEDATE OF EXPIRYAUTHORITY

5. Student’s place of work:

OCCUPATIONEMPLOYERPHONE NUMBER

6. Student’s marital status:  SingleMarriedDivorced

Spouse’s full name:

Spouse’s place of work:

OCCUPATIONEMPLOYERPHONE NUMBER

7.Please, indicate how much you plan to spend on the following in the 2017-2018:

a. Housing (and utilities)$/ month

b. Food$/ month

c. Transportation$/ month

d. Clothing$/ month

e. Mobile Phone$/ month

f. Health/Dentistry$/ month

g.Loan Repayment/$/ month

h. Financial obligations$/ month

j. Other personal expenses

(specify)$/ month

8. Do you have any relatives who depend on you and your family financially?

If so, please explain below, and provide appropriate supporting documents.

9. During 2016, how much household income came from the following sources?

10. Does your family own its home? YesNo(If Yes, complete a below).

a. What is its present market value? $

11. Please list the value of the following family assets (if applicable):

12. Do you or your family own a vehicle(s) or have a vehicle(s) by proxy?YesNoIf Yes:

a. $

VEHICLE BRANDYEAR OF MANUFACTUREYEAR OF PURCHASEORIGINAL PURCHASE PRICE

b. $

VEHICLE BRANDYEAR OF MANUFACTUREYEAR OF PURCHASEORIGINAL PURCHASE PRICE

c. $

VEHICLE BRANDYEAR OF MANUFACTUREYEAR OF PURCHASEORIGINAL PURCHASE PRICE

13. Other assets (agricultural equipment, livestock [cattle, sheep, horses], etc.)

Include amount or number:

a. Type: Value: $______

b. Type: Value: $______

c. Type: Value: $______

14. How much are you ready to pay for tuition per annum? $______

15. Enter the expected amount of support toward your tuition for 2017-2018from the sources listed below:

Relatives and friends $

Your government $

Agencies and foundations $

Private sponsor (explain) $

Other (explain in your essay) $

16. Sponsor’s Guarantee. (Except parents of an applicant)

In case you have a sponsor, please, request that your sponsor(s) fill in and sign the following section in addition to attaching their financial documents to this form.

Sponsor 1.

I, ______, the sponsor of the above student agree to support his or her education to the amount of $ ______during his or her study at the Masters of Art Program in Psychology at the American University of Central Asia.

Sponsor’s Signature Date

Sponsor 2.

I, , the sponsor of the above student agree to support his or her education in the amount of $ ____ during his or her study at the Masters of Art Program in Psychology at the American University of Central Asia.

Sponsor’s Signature Date

We certify that all the information provided in this application is complete and true. The American University of Central Asia has our permission to verify the information reported by obtaining documentation as needed. We agree to provide the University with power of attorney when necessary to request our financial information in any private organization and state agencies. We hereby express our consent to provide University officials with an opportunity to visit us in our place of living during the period of student’s studying with view of respective examination. We understand that any misrepresentation or omission or a failure to provide supporting documents may be a cause for denying financial assistance or expulsion from the American University of Central Asia. We understand that the University reserves the right to deny financial assistance to anyone whom it considers not qualified, and to require withdrawal of any student at any time for any reason it considers sufficient, including academic standing, and personal conduct. We certify that all information regarding financial aid will be kept confidential. We know that breaching confidentiality may result in discontinuation of the financial aid. We also certify that we act voluntarily and we lay no claims against the University.

Student’s Signature: Date:

Spouse’ssignature: ______Date:

Dear applicants and students, information you provide while applying for financial aid must be accompanied with the following official documents listed below:

*NOTE: All documents must be originals or notarized copies.

*If an applicant sends documents by e-mail, original documents must be brought to Financial Aid office room G20 upon arrival to AUCA.

*Documents are accepted only in Kyrgyz, Russian or English. If your documents are in other language, you are required to provide official translation of documents.

Уважаемые абитуриенты и студенты, данные, указанные Вами в заявлении на финансовую поддержку, должны быть подтверждены нижеперечисленными официальными документами:

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