INTERNATIONAL STUDENT FINANCIAL SUPPLEMENT

This page should only be completed by international students.

STUDENT INFORMATION
Name:
Last First Middle

Marital Status:

Single/Divorced/Separated/Widowed Married/Remarried/Partnered

Nationality: Visa Status: On Campus Off Campus You: Your Spouse: You: Your Spouse: Living with Parents $ $ $ $ $ $ $ $ Yes Yes Yes, ___ Yes No No No No

ANTICIPATED HOUSING ARRANGEMENT - Your response will help us estimate your expenses for 2012-13. This is not an
application for on-campus housing and will not affect your housing status.

INCOME DATA Do not leave any blanks. Convert all figures to U.S. Dollars.
Total gross income (before taxes) for 2011 for: Total amount of your income tax for 2011 for:

Rate of Exchange: $1 US =

Money received, or paid on your behalf, from sponsors, relatives other than parents, and trust funds: Total current balance of cash, checking, and savings accounts: Current net worth of investments (include trust funds; do not include primary residence or retirement funds): Current net worth of business, if you own a business:

DEPENDENCY STATUS DETERMINATION

Were you born before January 1, 1989? Will you be working toward a graduate degree (i.e. MM, MFA, GD, etc.) in 2012-13? Do you have children or dependents (other than a spouse) who receive more than half their support from you? If yes, how many? Are you an orphan (both parents deceased)?

PARENT INFORMATION
Parents marital status: Married/Remarried/Partnered Single/Divorced/Separated/Widowed How many people are in your parents household (including yourself)? How many people in your parents household will be college students during the 2012-13 school year? Parents dates of birth:
Month

/
Day

/
Year

and
Month

/
Day

/
Year

INCOME DATA Do not leave any blanks. Use the same rate of conversion noted in Student Information.
Parents total gross income (before taxes) for 2011: Total amount of your parents income tax for 2011: Total current balance of cash, checking, and savings accounts: Current net worth of investments (include trust funds; do not include primary residence or retirement funds): Current net worth of business, if your parents own a business: Parent 1: Parent 2: Parent 1: Parent 2: $ $ $ $ $ $ $

VERIFY INFORMATION
I certify that the information offered on this application is true and complete. I hereby give permission for The Juilliard School to request any follow-up documentation as necessary, including tax transcripts from the IRS. I agree to notify the Office of Financial Aid promptly in writing if additional financial resources become available to me after filing this application. I understand that the Office of Financial Aid reserves the right to adjust aid if necessary based on such resources. Student Signature:
By typing your name, you agree to the terms listed above

Date: Date:
Necessary only if information is required on page two

Parent Signature: