Resident Scholarship Application
Spring 2016
Deadline: November 22, 2015
Instructions:
1. Use the tab key to complete all the fields on the application. Budget calculations will automatically be
done for you but please check for accuracy.
2. Save the application and send it together with all supplemental documents by 11:59pm on November
22, 2015 to Megan Amouzou in the Admissions Office.
Please select the scholarship you are applying for based on the eligibility criteria described on the I-House
website:
Dodge Foundation Middle East Scholarship
Mitsui USA Scholarship
Performing Artist in Residence Scholarship
Resident Scholarship
Resident Member Gift Campaign Scholarship
Toyota Motor Corporation Scholarship
Although you may be eligible for more than one of the above programs it is only possible to receive one.
Please be sure you have included all required attachments listed in the checklist for each scholarship.
Incomplete applications will not be reviewed until they are completed. Award of a scholarship is contingent
on admission and you will not learn of the scholarship decision prior to the admission decision.
Basic Information
Last Name:
First Name:
E-Mail Address:
Status (click to select): Please Select
Name of Academic or Training Institution in NY for Spring 2016:
Field of Study:
Expected Completion Date:
Degree:
Please list the names, ages and relationship of family members who reside with you at I-House:
Financial Statement
Why are you applying for financial aid at this time? Please describe your financial situation including any
changes in your financial circumstances which have occurred recently.
Budget
Please complete the budget below indicating both your resources and expenses for (check one):
2016 Spring Semester
(January-May)
Other:
(specify dates)
Please be consistent and provide all figures for the same period of time.
Resources
Total
Personal
Total Savings*
Work*
Family/Sponsor
Amount of support-gift*
Amount of support-loan*
External
Scholarship/Tuition Waiver* (specify name)
Scholarship* (specify name)
Grant/Fellowship/Assistantship* (specify name)
Student loans*
Other loans*
Other income* (specify source)
Grand Total Income
$0.00
Note: If you have applied for funding and are still awaiting the results
please indicate what you estimate to receive and note when you will be
able to provide verification. The Admissions Committee cannot finalize its
decision without this information and it may be necessary to wait until we
know exactly what your financial circumstances are.
Expenses
Total
Academic
Tuition and fees (
per semester x
semesters) =
$0.00
Books & Supplies (
per semester x
semesters) =
Average estimate is $500 per semester
$0.00
Loan repayment* (
$0.00
per month x
months) =
Living
I-House fees (
per month x
Including the Dining Fee
Food (
months) =
$0.00
per month x
months) =
Average estimate is $300 per month
$0.00
Telephone (
per month x
months) =
Average estimate is $75 per month
$0.00
Transportation (
per months x
months) =
Average estimate is $112 per month for a metro card
$0.00
Personal
Clothing & Personal Items (
per month x
Average estimate is $125 per month
months) =
$0.00
Expected medical (
per month x
months) =
Average estimate is $100 per month
$0.00
Entertainment (
per month x
months) =
Average estimate is $100 per month
$0.00
Credit Card payments* (
$0.00
per month x
months) =
Other-list anything not included above
Other (specify):
Other (specify):
Grand Total Expenses
$0.00
Grand Total Expenses – Grand Total Income = $0.00
STOP
Please carefully review the accuracy of your figures
STOP
If your estimate for any of the expenses above differs from the average estimate please provide an
explanation here.
Application checklist
Please submit the following items (incomplete applications will not be considered):
Complete Scholarship Application form
Written financial statement
Complete and accurate budget
Verification of financial information of items with an asterist (*)
Résumé / C.V.
Verifying documentation, where denoted by an asterisk (*), is required and must be included. Your application
will not be complete without it.
Once completed, save the application and send it together with all supplemental
documents by November 22, 2015 to Megan Amouzou in the Admissions Office.
The information that I have submitted is true and correct. I understand that any misrepresentation of the
information submitted will disqualify me from consideration. I understand that the information contained in this
application is confidential and will only be shared with the members of the I- House Admissions Committee and
the President. I also understand that if I receive assistance, my name and my photo, but not any amount I may
receive, may be made public.
Agreed upon by
Date Click here to enter a date.