statement of means of biological ... - bermuda scholarships · bursaries/scholarships government...

STATEMENT OF MEANS OF BIOLOGICAL PARENTS OR LEGAL GUARDIANSAll information will be kept strictly confidential. Further documentation may be required.

Family Information:Mother/Legal GuardianName:Occupation and employer:No. and ages of dependants:(for whom you are financially responsible)

Marital status:

Annual Income (A): $

(NB: total for household in which student resides)

Mother/guardian income

Father/guardian income

Student income (scholarship/summer employment)

Income from additional wage earner

Is Student self funded? Y/N

Other Income:

Rental income

Dividends/stocks

Child support

Gifts

Bursaries/scholarships

Government assistance

Other income (please specify)

Total Annual Income:

Annual Expenses (B): $

Mortgage

Rent

Land tax

Annual loan repayments

Child support/alimony

Food

Clothing

Insurance Premiums:

Buildings/contents

Health/life

Vehicle

Utilities:

Electricity

Cable TV

Gas

Phone (cell & land line)

Water

Extra-curricular/entertainment/vacation

Exceptional medical expenses

School fees for applicant (total below)

School fees for other dependants

Other expenses (Please specify)

Total Annual Expenses:

Net Income (expense) being (A) less (B):

Liabilities (D): $

Mortgage on home

Mortgage on other properties

Car loan

Boat loan

Personal loan

Credit Card ourstanding balance

Other liabilities (please specify)

Total Liabilities:

Net Income (expense) being (C) less (D):

Name of Guardian

Signature

Date

Name of Student

Signature

Date

Please outline how you plan to fund University expenses:

I/We hereby declare that the information provided herein is true and complete and that no information is omitted in relations to any of the items describing my/our income and expenses, and that I understand that, should the information provided be found to be incorrect, any financial assistance may be withdrawn. Failure to make a full and accurate disclosure will invalidate this application.

Assets (C): (total household) Year: $

House (year of purchase & purchase price)

Other property

Car

Bike

Boat

Savings / Other assets

Investments

Shares

Savings

Other assets (please specify)

Total Assets:

Student’s Statement of Education Costs

Expenses

Tuition

Room and board

Fees

Books and supplies

Travel and transportation

Other (please specify)

Total Annual Education Costs:

Father/Legal GuardianName:Occupation and employer:No. and ages of dependants: (for whom you are financially responsible)

Marital status: