Smith Aid Application/Traditional U.S. Students
Name
2016-2017
Email Address:
Smith ID or Last 4 digits of SSN:
Date of Birth:
The information you provide on this document will help us determine your eligibility for aid in 2016-2017.
Household Information:
List the people that your parent(s) will support between July 1, 2016 and June 30, 2017. Include:
 yourself and your parent(s) you live with (including stepparent), and
 your parent(s)' other children, even if they don't live with your parent(s) if (a) your parents provide more than half of their support
from July 1, 2016 through June 30, 2017, or (b) the children would be required to give parental information when applying for
Federal student aid, and
 other people if they now live with your parents and your parents provide more than half their support and will continue to provide
more than half their support from July 1, 2016 through June 30, 2017.
Write the names of all household members. Also write in the name of the college for any household member, excluding parent(s), who
will be attending college at least half-time between July 1, 2016 and June 30, 2017, and will be enrolled in a degree or certificate
program. If you need more space, attach a separate page.
Full Name
Age
Sophia Smith (example)
18
Date of Birth
(Siblings
only)
Relationship
College
Enrollment
(FT/PT)
Sister
Central University
PT
Self
Additional Information:
A. If your parents are divorced or separated, please give us the name of your custodial parent: ______________________
Please give us the name of your non-custodial parent: _________________________________
B. Please attach a separate piece of paper with any additional information you feel may affect your financial aid eligibility.
How much of your 2016-17 educational costs can be paid by:
A.
B.
Direct contribution from:
1. parents or relatives
$
__________
2. your savings, investments, or trusts
$
__________
3. educational benefits from Veterans
Administration, parent’s employer,
Rehabilitation, or E.T. (circle source)
$
__________
Savings from your summer earnings
$
__________
Student’s employer
_______________________________
Student Assets:
A.
Give details on student’s assets
Current Value
Cash and savings
$
__________
Uniform Gifts to Minors
$
__________
Stocks, bonds, CDs, and other investments
$
__________
Trust Funds
$
__________
B. List student's other assets (car, real estate, etc.):
Asset
Purchase Price
Date of Purchase
Current Value
_______________________________________________________________________________________
_______________________________________________________________________________________
Outside Scholarships and Loans: (Policy can be found at www.smith.edu/sfs/aid_outside.php)
If you expect to receive any outside scholarship or loan awards for 2016-2017 please complete the following information. Do not include
Federal Pell or state grants, Federal Direct or Perkins loans.
Name of award
Amount
Type (Scholarship or loan)
1. ___________________________________________________________________________________________
2. ___________________________________________________________________________________________
3. ___________________________________________________________________________________________
It is your responsibility to inform us of outside aid; if we learn of any outside awards after July 1, the grant portion of your award
may be reduced by the full amount of the award.
Student Account Authorization
I, the student, authorize Smith College to apply Federal Title IV financial aid funds to allowable institutional charges such as tuition,
room, board, and required fees and also to other educationally related expenses that might be posted to my student account.
Examples of other charges are computer software and equipment, optional health insurance charges and other medical expenses, late
payment fees and bad check fines, library fines and miscellaneous housing charges.
I understand that this authorization can be rescinded at any time by submitting a signed statement to Student Financial Services.
Authorization:
Yes _____
No _____
Statement of Eligibility
I certify that I, the student, am not in default on any Federal Family Educational Loan Program (Guaranteed Student Loan/Stafford Loan,
National Direct/Defense/Perkins Loan, or PLUS/SLS Loan) and that I do not owe a refund on any Federal Title IV - Higher Education
Act grant (Pell, Supplemental Educational Opportunity Grant or State Student Incentive Grant) for attendance at Smith College or any
other educational institution and I do not own property subject to a judgment lien for a debt owed to the United States.
I attest that the information provided is true and accurate to the best of my knowledge.
____________________________________ ___________
Your Signature (Student)
Date
____________________________________ ____________
Parent Signature
Date
If you are in default, or owe a refund, contact Student Financial Services immediately.
If you are not required to file a 2015 tax return, please complete a Non-Filer Statement found on our website at
www.smith.edu/sfs/apply_current_traditional.php or www.smith.edu/sfs/apply_prospective_traditional.php.
S:\FAO\Forms -Student Use\Forms 2016-17\Smapp 1617-trad.doc