Office of Pre-College Programs, Barnard College, 3009 Broadway, New York, NY 10027
(P) 212.854.8866 • (F) 212.854.8867 • [email protected] • www.barnard.edu/summer
2015 Need-Based Scholarship Application (Optional)
Barnard’s Summer Pre-College Program will be offering a number of partial scholarship awards as well as one full scholarship
for each of the programs to residents and commuters. All scholarships are based on financial need.
Instructions:
To be considered for a scholarship, we must receive the following:
1) your completed Summer Program Application including transcript, letters of recommendation, and required application fee;
2) your Need-Based Scholarship Application Form;
3) your signed copy of the parents’ and student’s 2013 federal income tax (including all pages and schedules) or 2014 if you
have received it;
4) if using your 2013 return: a cover letter stating any significant changes in circumstances for your 2014 tax return, such as a
loss of job, move to a new residence, or new job;
5) all applicable W-2(s)
Completed scholarship applications may be emailed to [email protected], faxed to 212-854-8867, or mailed to The Office of
Pre-College Programs, Barnard College, Room 017 Milbank Hall, 3009 Broadway, New York, NY 10027
Decisions regarding partial scholarships will be released on a rolling basis with your admissions decision. Full scholarship
decisions will be released on May 4, 2015. Should you be considered for a full-scholarship, we will notify you with your
admissions decision, as well as inform you of a partial scholarship amount should you not receive the full scholarship.
Please note that you must check the box on your program application notifying us that you will apply for a
scholarship. We will not accept any scholarship applications if a student has not notified our office on their program
application.
DEADLINE TO APPLY: April 10, 2015
If your parents are separated or divorced, both the custodial and non-custodial parent are required to submit proof of
income to apply for assistance. Information can be sent in separate envelopes addressed to the Pre-College Office.
Each parent must submit items 2-5 mentioned above. The custodial parent is the parent with whom the student resides.
If either parent has remarried, the income from the new family unit must be reported on the application because the
income and assets of the entire new family unit is considered pertinent to the parents’ ability to contribute to the cost of
the program.
Student’s Name:
Social Security Number:
Mailing Address:
Phone Number:
Email:
Cell Phone Number:
Are you a U.S. citizen or permanent resident?  Yes  No
Date of Birth (MM/DD/YY):____________________
Program (please select your program choice):
 Summer in the City (4-weeks) includes Summer Science Seminars
 Liberal Arts Intensive (1-week) includes Summer Science Seminars
 Entrepreneurs-in-Training (11 days)
 Young Women’s Leadership Institute (9 days)
 Dance in the City (11 days)
 Are you applying with the aid of a CBO such as Minds Matter, OSSE, Joyce Ivy, Schuler Scholars? If so, please
name_________________________________________
Household Information:
1. Number of family members in 2014-2015 including the applicant_____________________________________
2.
Number of children claimed on 2014 tax return who will be attending college in 2015-2016_________________
a.
Age of children attending college in 2015-2016____________________________________________
b.
School(s) that children will be attending in 2015-2016_______________________________________
_________________________________________________________________________________
3.
Parents’ marital status:  Single  Married  Separated  Divorced  Widowed
4.
Check:  Father  Stepfather  Guardian
Check:  Mother  Stepmother  Guardian
Name:_________________________________
Name:___________________________________
Address same as above?  Yes  No
Address same as above?  Yes  No
If not, please indicate _____________________
If not, please indicate _____________________
_______________________________________
_______________________________________
_______________________________________
_______________________________________
Occupation/Employer ____________________
Occupation/Employer ____________________
______________________________________
______________________________________
______________________________________
______________________________________
Title/Position ___________________________
Title/Position ___________________________
______________________________________
______________________________________
Business Phone ________________________
Business Phone ________________________
5.
Age of Older Parent_____________________
Parents’ Income Information (2014)
1. Father or stepfather: Wages, salaries, tips, and other compensations_________________________________
2.
Mother or stepmother: Wages, salaries, tips, and other compensations________________________________
3.
Untaxed Income Benefits
a.
Welfare Benefits (including AFDC & TANF)
___________________________
b.
Earned income
___________________________
c.
Additional Child Tax Credit
___________________________
d.
Social Security
___________________________
e.
Payments to tax deferred pension & savings plans
___________________________
f.
Self-employed SEP & SIMPLE qualified plans
___________________________
g.
IRA deductions
___________________________
h.
Child Support Received
___________________________
Total Untaxed Income (add lines “a” through “h”)
___________________________
Family Asset Information
Cash, Savings,
Parent’s
Checking
Accounts
What is it worth
today?
What is owed on
it?
Student’s
Cash, Savings,
Checking
Accounts
Investments
Home
Other Real
Estate
Business/Farm
Investments
Home
Other Real
Estate
Business/Farm
What is it worth
today?
What is owed on
it?
Family Contribution
Please give us a realistic and accurate amount that you can contribute towards the Pre-College Program tuition
$ __________ (If this space is left blank we are unable to consider the applicant for any scholarship, even if he or she
meets award criteria).
Special Circumstances
Please use this space to explain any unusual expenses or special circumstances.
Attach additional pages, if necessary.
______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
Certification
I/we certify that the information furnished in this statement is complete and correct to the best of my/our knowledge.
Signature of student
applicant
_______________________________________
Date_______________________
Signature parent/legal or
guardian (if other than
parent)
_______________________________________
Date_______________________
Signature parent/legal or
guardian (if other than
parent)
_______________________________________
Date_______________________
Forward this form with a copy of your W-2 forms and your completed and signed 2013/4 federal tax return.
Keep a copy of this form for your records. ADMISSION APPLICATIONS AND SCHOLARSHIP APPLICATION
WILL NOT BE CONSIDERED WITHOUT THE REQUIRED APPLICATION FEE.
Please return the completed copy to the Office of Pre-College Programs
Barnard College, 3009 Broadway, New York, NY 10027, (fax) 212.854.8867, [email protected]