Ursinus College International Student Financial Statement

Student Information

First Name

Middle Name

Last Name

Birthdate

Mailing Address

Country

Street

City

Region

Postal Code

Email Address

Country of Birth

Country of Citizenship

Parent Information

Parent 1

Name

Age

Occupation/Title

Employer

Parent 2

Name

Age

Occupation/Title

Employer

Household Size

How many people do your parents support within your household? Include yourself, your parents, siblings, and any other dependents who are supported by your parents and reside in your household.

1. Name

Age

Relationship to you

College Attendance Status (If this person is attending college at least half-time in the upcoming academic year as a degree-seeking undergraduate)

Half-Time

Full-Time

Name of College

College Grad Year

Anticipated Parental Contribution (in US dollars)

2. Name

Age

Relationship to you

College Attendance Status (If this person is attending college at least half-time in the upcoming academic year as a degree-seeking undergraduate)

Half-Time

Full-Time

Name of College

College Grad Year

Anticipated Parental Contribution (in US dollars)

3. Name

Age

Relationship to you

College Attendance Status (If this person is attending college at least half-time in the upcoming academic year as a degree-seeking undergraduate)

Half-Time

Full-Time

Name of College

College Grad Year

Anticipated Parental Contribution (in US dollars)

4. Name

Age

Relationship to you

College Attendance Status (If this person is attending college at least half-time in the upcoming academic year as a degree-seeking undergraduate)

Half-Time

Full-Time

Name of College

College Grad Year

Anticipated Parental Contribution (in US dollars)

5. Name

Age

Relationship to you

College Attendance Status (If this person is attending college at least half-time in the upcoming academic year as a degree-seeking undergraduate)

Half-Time

Full-Time

Name of College

College Grad Year

Anticipated Parental Contribution (in US dollars)

6. Name

Age

College Attendance Status (If this person is attending college at least half-time in the upcoming academic year as a degree-seeking undergraduate)

Half-Time

Full-Time

Relationship to you

Name of College

College Grad Year

Anticipated Parental Contribution (in US dollars)

7. Name

Age

College Attendance Status (If this person is attending college at least half-time in the upcoming academic year as a degree-seeking undergraduate)

Half-Time

Full-Time

Relationship to you

Name of College

College Grad Year

Anticipated Parental Contribution (in US dollars)

8. Name

Age

College Attendance Status (If this person is attending college at least half-time in the upcoming academic year as a degree-seeking undergraduate)

Half-Time

Full-Time

Relationship to you

Name of College

College Grad Year

Anticipated Parental Contribution (in US dollars)

9. Name

Age

College Attendance Status (If this person is attending college at least half-time in the upcoming academic year as a degree-seeking undergraduate)

Half-Time

Full-Time

Relationship to you

Name of College

College Grad Year

Anticipated Parental Contribution (in US dollars)

10. Name

Age

College Attendance Status (If this person is attending college at least half-time in the upcoming academic year as a degree-seeking undergraduate)

Half-Time

Full-Time

Relationship to you

Name of College

College Grad Year

Anticipated Parental Contribution (in US dollars)

Income

What documentation will you be providing to verify income and asset information requested on this form?

Tax Forms

Payslip

Bank Statement

Financial Documentation

Does your government currently impose restrictions on the exchange and release of funds for study in the United States?

Yes

No

Do you have a source of emergency funds once you arrive in the United States?

Yes

No

Name of source:

Amount Available in U.S. dollar:

Do you have a source of funding to cover your air transportation to the United States?

Yes

No

Maybe

Please name source:

Income Information
Please answer all questions in US Dollars. Bank statements and any contributions being made through income should be submitted on the bottom of this form. Additional documentation may be requested to support the statements made on this form.

As of today, the present exchange rate of your country’s currency rate to the U.S. dollar (= $1.00 (U.S.)

How many people outside your household depend on the income of your parents for daily living expenses?

During 2023, how much of your household income (before taxes or expenses) came from the following sources?

Parent 1 Earnings - Amount in US Dollars

Parent 2 Earnings - Amount in US Dollars

Students Earnings - Amount in US Dollars

Family Business - Amount in US Dollars

Housing, food, or other allowances - Amount in US Dollars

Real Estate Holdings - Amount in US Dollars

Pension/Annuity - Amount in US Dollars

Taxes Paid - Amount in US Dollars

Interests/Dividends - Amount in US Dollars

Other - Amount in US Dollars

Will there be a significant increase or decrease in your family’s income next year?

Yes

No

If Yes, please explain:

Asset Information

Do your parents/legal guardians have a bank account?

Yes

No

Does your family own its home?

Yes

No

Year Purchased

Original Purchase Price - Amount In U.S. Dollars

Amount owed on home - Amount In U.S. Dollars

Current market value - Amount In US Dollars

Does your family own a business?

Yes

No

Date business commenced

Parents’ share of business value - In US Dollars

Parents’ share of business debt - In US Dollars

Type of business

List the values of the following assets:

Checking/Savings (Amount In US Dollars)

Investments (Amount In US Dollars)

Assets in Siblings Name (Amount In US Dollars)

Assets owned by student (Amount In US Dollars)

Special Circumstances - Use this space to explain any unusual expenses, other debts, or special circumstances that Ursinus College should consider when it is deciding how much financial aid, if any, you will receive.

Expenses

How much did your family spend on the following expenses during 2024? Specific Amounts are needed. (Write in the annual amount in US Dollars your family spent on the items listed. If you do not know the actual amount, please estimate.)

Rent or Mortgage

Utilities

Food

Clothing

Household necessities

Standard Annual Care Medical expenses

Supplemental Emergency Medical expenses

Educational expenses

Loan payments

Taxes

Public Transportation expenses

Care for relatives

Amount allocated to savings/retirement

Automobile maintenance

Insurance (health and property)

Entertainment/Vacation

Household Staff

Other

How much money does your family owe to other people or to financial institutions?

Support for Educational Expenses

Indicate the dollar amount from each category that will go towards your educational expenses (in US dollars). Enter the combined total at the bottom.

Contribution from Parent Assets - Academic Year 2025-2026

Contribution from Parent Income - Academic Year 2025-2026

Contribution from Your Assets - Academic Year 2025-2026

Contribution from Your Income - Academic Year 2025-2026

Contribution from Relatives & Friends - Academic Year 2025-2026

Contribution from Your Government - Academic Year 2025-2026

Contribution from Agencies/Foundations - Academic Year 2025-2026

Contribution from Private Sponsors - Academic Year 2025-2026

Contribution from Other - Academic Year 2025-2026

COMBINED TOTAL - Academic Year 2025-2026

Certification & Authorization

We declare that the information on this form is true, correct, and complete. Ursinus College has our permission to verify information reported by obtaining documentation as needed. We understand that providing false information may jeopardize the student’s visa status and may result in revocation of admission.

Electronic signature of applicant

Date

Electronic signature of parent

Date