STUDENT NAME
	last	first	middle

Date of Birth:  /  /

1. OUTSIDE AID

Are there any scholarships, grants, fellowships, assistantships, veteran's benefits, Native American grants, athletic tenders, grants-in-aid, fee remissions, ROTC, etc., not administered by the Office of Student Financial Services that you will receive during summer 2001 or the 2001-2002 academic year?
Yes No

If yes, please list below.  (Do not list Federal Pell Grants or loans.)
(NOTE: If after submitting this form you learn that you will receive any of the above mentioned funds, notify us in writing immediately.) 

Name & Type of Award	Granting Agency	Summer Amt	Ac/Yr Gross Amt
		$	$
		$	$
		$	$
		$	$
		$	$

2.  CHANGES IN STUDENT INCOME

a.	Did you work full time (at least 35 hours/week or more) for at least 20 weeks in 2000?	Yes   No
	If yes, go to item 2b.  If no, skip the rest of item 2 and go to item 3.
b.	Will you be or are you working full-time during the 2001-2002 school year?	Yes   No
	If yes, go to item 3. If no, and if your 2000 income is not an accurate reflection of your 2001 income complete items c through f below. (other wise go to item 3).
		Summer 2001 (June-August)	2001-2001 (Sept-May)
c.	Student's gross income earned from work, before taxes and deductions: (do not include earnings from work-study jobs)	$	$
d.	Spouse's gross income earned from work, before taxes and deductions:	$	$
e.	Other taxable income, such as interest, dividends, business/farm income, alimony capital gains, etc.:	$	$
f.	Untaxed income and benefits, such as child support; cash support or money paid on your behalf; housing, food or other living allowances; Workers Compensation. etc.:	$	$

3.  SPECIAL CIRCUMSTANCES

Complete this section ONLY if there are special circumstances we should take into consideration when reviewing your application.  Examples include loss of a job, a death in the family, exceptionally high medical/dental expenses, and other changes that would result in a substantial decrease in income for you or your family. 

 

4.  MID-YEAR TRANSFERS ONLY (transferring to UW-Madison in January of 2002)

If you will attend another college or university during the period of June 2001 through December 2001 please list below the full name of the institution attended, including city and state.  You must submit to our office a Financial Aid Transcript from that institution.

Name, city and state of school	Period of Attendance (mo/yr)
	from / to /