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Graduate Student Parent Support Application
Eligible applicants will be considered for the ARCS Scholarship, the Kanel Scholarship, and the Parent Support Program funds. Applicants must be enrolled, in good academic standing, and making satisfactory progress towards their degree.
Applicant Information
UID
*
Name
*
First
Last
Option
*
Year of Study
*
Expected Graduation Date
*
Advisor
*
Citizenship
*
US Citizen
US Permanent Resident
Non-US Citizen (F-1, J-1, Other)
Contact Information
Email
*
Home Address
*
Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
Antigua and Barbuda
Aruba
Bahamas
Barbados
Belize
Canada
Cayman Islands
Cook Islands
Costa Rica
Cuba
Dominica
Dominican Republic
El Salvador
Grenada
Guatemala
Haiti
Honduras
Jamaica
Mexico
Netherlands Antilles
Nicaragua
Panama
Puerto Rico
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Trinidad and Tobago
United States
Argentina
Bolivia
Brazil
Chile
Colombia
Ecuador
Guyana
Paraguay
Peru
Suriname
Uruguay
Venezuela
Albania
Andorra
Armenia
Austria
Azerbaijan
Belarus
Belgium
Bosnia and Herzegovina
Bulgaria
Croatia
Cyprus
Czech Republic
Denmark
Estonia
Faroe Islands
Finland
France
Georgia
Germany
Greece
Hungary
Iceland
Ireland
Italy
Kosovo
Latvia
Liechtenstein
Lithuania
Luxembourg
Macedonia
Malta
Moldova
Monaco
Montenegro
Netherlands
Norway
Poland
Portugal
Romania
San Marino
Serbia
Slovakia
Slovenia
Spain
Sweden
Switzerland
Ukraine
United Kingdom
Vatican City
Afghanistan
Bahrain
Bangladesh
Bhutan
Brunei Darussalam
Myanmar
Cambodia
China
East Timor
Hong Kong
India
Indonesia
Iran
Iraq
Israel
Japan
Jordan
Kazakhstan
North Korea
South Korea
Kuwait
Kyrgyzstan
Laos
Lebanon
Malaysia
Maldives
Mongolia
Nepal
Oman
Pakistan
Palestine
Philippines
Qatar
Russia
Saudi Arabia
Singapore
Sri Lanka
Syria
Taiwan
Tajikistan
Thailand
Turkey
Turkmenistan
United Arab Emirates
Uzbekistan
Vietnam
Yemen
Australia
Fiji
Kiribati
Marshall Islands
Micronesia
Nauru
New Zealand
Palau
Papua New Guinea
Samoa
Solomon Islands
Tonga
Tuvalu
Vanuatu
Algeria
Angola
Benin
Botswana
Burkina Faso
Burundi
Cameroon
Cape Verde
Central African Republic
Chad
Comoros
Democratic Republic of the Congo
Republic of the Congo
Djibouti
Egypt
Equatorial Guinea
Eritrea
Ethiopia
Gabon
Gambia
Ghana
Gibraltar
Guinea
Guinea-Bissau
Cote d'Ivoire
Kenya
Lesotho
Liberia
Libya
Madagascar
Malawi
Mali
Mauritania
Mauritius
Morocco
Mozambique
Namibia
Niger
Nigeria
Rwanda
Sao Tome and Principe
Senegal
Seychelles
Sierra Leone
Somalia
South Africa
Sudan
Swaziland
United Republic of Tanzania
Togo
Tunisia
Uganda
Zambia
Zimbabwe
Country / Region
How many people reside in your household?
*
Indicate the name and relationship to the applicant for each member of the household
*
Name
Relationship
Household member 1
Household member 2
Household member 3
Household member 4
Household member 5
Cost of Attendance
Estimate your household expenses for the past 12 months
*
Annual Estimate $
Housing
Food
Utilities
Books/Supplies
Transportation
Personal
Dependent Expenses
Annual Estimate $
Childcare (*please provide details below)
Insurance
Other (please specify)
*Type of childcare
For each child, please indicate the type of childcare expenses (i.e., CCC/CEC or private daycare/nursery tuition, babysitter or nanny, private school, public school, etc.)
*
Annual Estimate $
Total Expenses (Household + Dependent)
Spouse/Partner Information
Name
First
Last
Employment (select all that apply)
Employed/Self-Employed
Full-time student
Part-time student
Not employed
Ineligible to work in US due to visa status
Dependent Information
Please list children from youngest to oldest
Name
Date of Birth
Age
Child 1
Child 2
Child 3
Household Income
*
Annual Amount $
Applicant's gross annual wages/stipend
Spouse/Partner gross annual wages/stipend
Other Family Income (Veteran’s Benefits, Spousal Support, Child Support, Unemployment, Dividends/Interest, etc.)
Please include any special circumstances of financial hardship not addressed as part of the application. (Optional)
I certify that the information reported is true, correct and complete. I agree to provide, if requested, any necessary documentation to support the application and acknowledge that my advisor may be contacted to verify satisfactory academic progress.
Signature
*
Clear