University of Wisconsin-Madison
FAMILY INFORMATION FORM (FIF) 2001-2002

DO NOT COMPLETE THIS FORM IF ANY OF THESE CONDITIONS APPLY TO THE STUDENT : 1) If you were born before January 1, 1978; 2) If you are married; 3) If you are a veteran of the U.S. Armed Forces; 4) If you are a ward of the court or both your parents are deceased; or 5) If you have legal dependents other than a spouse.

STUDENT NAME
last first middle

Student Social Security Number

ALL QUESTIONS BELOW SHOULD BE ANSWERED BY THE PARENT(S)

1. PARENT OCCUPATION/EMPLOYER

Please list parents' occupations or emplooyers below.  If parents are separated or divorced, please list information about the parent not completing this form in item 4 below.

Occupation/employer - father No. of years with this employer
Occupation/employer - mother No. of years with this employer

2.  HOME OWNERS

Do you own a home?    Yes No
If yes, please complete the rest of this item and then go to item 4; if no, go to item 3.

What is home worth today? $ What is owed on it? $
What year was it purchased?

  

 Monthly home mortgage $/mo.
What was the purchase price? $

3.  RENTERS

What is your monthly rental payment? $/mo.

If none, please explain

4.  DIVORCED/SEPARATED PARENTS

Student's parents are (choose one):
Separated (No Court Action) Date of Separation
Legally Separated Date of Court Action
Divorced Date of Divorce

If parents are divorced or separated, complete this section about the parent with whom the student lived with the least in the last 12 months.  If the student did not live with one parent less than the other in the last 12 months, complete this section about the parent who provided the least financial support.

Other parent's name:
Home address: street city state
Occupation or Employer: No. of years with this employer:

Does the parent listed above contribute directly to the student's educational expenses?  Yes No
If yes, please estimate the amount you anticipate will be contributed during the 2001-2002 academic year: $

Indicate below how much, in each category, you received from the other parent in 1999.  If the amount paid to you differs from the amount stipulated by the courts, please explain.  Enter "none" if the answer is zero.

Monthly Amount in 2000 2000 Amount (total received 1-00 to 12-00)
Child Support $ $
Family Maintenance $ $
Alimony $ $

5.  SPECIAL CIRCUMSTANCES:

Indicate any circumstances that we should take into consideration when reviewing your application, such as a substantial increase or decrease in your 2001 income, unusual medical/dental expenses, or dramatic family changes.