UISG and ECGPS
Earn While You Learn Scholarship Information
Fall 2014
Application for International Students in F-1 or J-1 Status
Enrolled University of Iowa students who work 15 hours a week or more are eligible for
this scholarship. Applications are due in the International Student and Scholar Services,
1111 University Capitol Centre, by 4:30 pm on Friday, December 19th, 2014.
1. In order to be eligible for the PSGI Earn While You Learn Scholarship you
must:
 Be a full time student during the semester you are to receive the
scholarship (registered for 12 s.h. for undergrads or 9 s.h. for grads)
 Have a minimum of $500 of unmet financial need
 Work a minimum of 15 hours per week (Documentation must be provided)
 Be in good academic standing with the University of Iowa and maintaining F1 or J-1 status
2. Students may only receive one award per academic year.
3. Eligibility will be determined by International Student and Scholar Services based
on the criteria listed above.
4. If there are more qualified applicants than scholarships available, priority
will be given to those who demonstrate the most need.
5. The award will be applied directly to recipient’s U-Bill in the Spring semester.
6. Applications will not be held over semester to semester but an applicant
may re-apply during the following year.
Fall 2014
Application for International Students in F-1 or J-1 Status
First Name:
Last/Family Name:
Student ID:
Major:
Expected Graduation:
 Undergrad
 Graduate019
Current Employment
Place of employment:
Is this a graduate assistantship?
 Yes
 No
Supervisor’s name:
Supervisor’s phone or email:
Number of hours worked each week:
Monthly salary amount:
Questions? Contact ISSS Advisor Kevin Roiseland at kevin-roiseland@uiowa.edu
2) Complete the following budget for your anticipated monthly income and monthly
expenses for the current semester. Use care in supplying information about your budget,
so that the subcommittee has a clear understanding of your financial situation.
MONTHLY
EXPENSES
Tuition:
Books:
Other Academic
Expenses:
Health Insurance:
Medical Expenses:
Rent:
Telephone:
Utilities:
Food:
Transportation:
Car Loans:
Credit Card Payments:
Other Loans:
Child Care:
Other Expenses:
EXPENSES TOTAL:
MONTHLY
INCOME
Income Source #1
Income Source #2
Income Source #3
Describe:
Describe:
Describe:
Income Source #4
INCOME TOTAL:
Describe:
Please understand you are expected to completely and
accurately list all income sources, including those that are
reflected on your most recent I-20 or DS-2019, as well as
any additional sources. If a source listed on your I-20 or
DS-2019 is no longer providing you with income, please
attach a letter of explanation. Applications where monthly
income information is inaccurate or incomplete will be
rejected without further review.
Is yours the only income in your household?
 Yes
 No
If no, what is the TOTAL monthly income in your household?
3) On a separate sheet of paper, describe your financial need. Include information on how
your financial situation has changed since you first became a student at the University of
Iowa, how that impacts your educational goals, and why your situation differs from that
faced by most other international undergraduate students here at the University of Iowa.
Indicate how this scholarship will help you achieve your educational goals.
I hereby certify that the information I have provided on this application form is accurate and complete, and provides the true portrayal of my
financial need. I understand that I may be asked to supply documentation in support of the statements I have made on this application. I hereby
authorize the University of Iowa International Student and Scholar Services to verify my enrollment and employment status in order to determine
eligibility for the UISG /ECGPS Earn While You Learn Scholarship, and to release the recipient list to the University of Iowa Student
Government for the purposes of selection, announcement, and publicity.
Signature
Date
Submit all application material to Kevin Roiseland, International Student and Scholar Services
1111 University Capitol Centre by 4:30 p.m. Wednesday, December 19, 2014