Graduate Life Office(GLO): Escondido Family Fund Application Form


Escondido Family Fund Application Form
To:	Android@stanford.edu
From (your full name):
Gender(male or female):
Social Security Number:
Your Email Address:
Student ID:
Campus Address:
Home Telephone:
Work Telephone:
Department or School:
Date of Matriculation:
Degree to which admitted:
Date degree expected(month):
Date degree expected(year):
---- Personal Information ----
Marital Status(single/married/separated/divorced/widowed):
Citizenship Status (US/Permanent-Resident/Non-Resident):
Spouse/Partner Name:
Spouse/Partner Employment/Academic Program/School:
---------------Children's Information-----------
child's name and age(1):
child's name and age(2):
child's name and age(3):
child's name and age(4):
child's name and age(5):
--This request is for what time period? (Check All that apply) --
Fall Quarter:
Winter Quarter:
Spring Quarter:
Summer Quarter:
Autumn Semester:
Spring Semester:
--------- Financial Data -----------
======== Section I: EXPENSES =========
Rent:
Food:
Household:
Telephone:
Medical & Insurance:
Dental costs unreimbursed:
Childcare (program/in-home):
Personal:
-- Loan payments --
Education loans:
Auto loans:
Other loans:
--- EDUCATIONAL COSTS ---
Tuition for year:
Books for year:
Academic Supplies for year:
Other education expenses:
Other education expenses:
Other education expenses:
Other Education Expenses:
---- Summarize All Section I Expenses Below ----
Total Expenses each Month (12-month basis):
Total Expenses Per Year (12-month basis):
======= RESOURCES: Section II ========
Fellowships:
Assistantship:
Grants:
Grants:
Personal monthly Earnings:
Spouse monthly Earnings:
Spouse Earnings:
Other, e.g. parents:
Alimony:
Loans:
Other Assets:
Other Assets:
Other Assets:
Other Assets:
Other Assets:
=== Summarize all Resources in Section II ===
Resources per Month(12-month basis):
Resources Total for Year(12-month basis):
=== List your TOTAL loan Debt below ===:
Total Loan Debt:

Please explain reason for requesting assistance from the Escondido Family Fund: