Cost of Attendance Form – Graduate Program
Maggie Picard
Scholarship Administration Associate
Email: [email protected]
Phone: 571-209-1107
Fax: 571-209-1775
Scholar name
Last
First
MI
► IMPORTANT INFORMATION REGARDING THIS AWARD
 The above student has been selected for a Jack Kent Cooke Foundation Graduate Scholarship. The Foundation will use the
information on page 2 to calculate the amount of the Scholar’s award for the 2015-16 school year.
 The Foundation expects that tuition, fees, stipends, and other costs for this student will not exceed those typically included on
other students’ cost of attendance forms and will examine all submissions for such discrepancies.
 This award is not intended to displace other aid, but is intended to help bridge the gap between the Scholar’s current aid and
the full cost of attendance at his/her institution.
 The Foundation will send the Scholar an award letter once the award amount is determined. The Scholar is responsible for
notifying the school of the award amount.
 Page 1 of this form must be completed by the Scholar.
 Page 2 of this form must be completed by the Financial Aid Office.
► INSTRUCTIONS FOR THE JACK KENT COOKE SCHOLAR
 Complete the Scholar name fields on pages 1 and 2 and all items on page 1.
 Email, fax or mail the form (with page 1 completed) to the financial aid office at your graduate institution and ask that they
complete page 2 and fax or email both pages directly to the Foundation by July 1, 2015.
 Check the Scholar section of the Foundation’s extranet to see if the Foundation received this completed form. If it is not
marked as received, contact your school to request the status of the form. It can take up to three weeks from the time the
Foundation receives the completed Cost of Attendance Form from your school to the time an award letter is mailed.
 Contact the Foundation if you have dependent expenses and would like the Foundation to consider them as part of your cost of
attendance. An additional form will be required.
 Sign the form at the bottom of page 1. By signing the form and submitting it to your financial aid office, you give
consent to the Jack Kent Cooke Foundation to obtain any information from the educational institution listed below
that is necessary to make scholarship determination and payment.
► Scholar Information
Scholar name:
Mr.
Ms.
Last:
Student ID number:
(Use your SSN if you do not have a school ID number)
First:
Email address:
Graduate institution:
City:
State:
Zip:
Field of study:
Degree sought:
Date of enrollment:
Expected graduation date:
Academic calendar:
Quarters
Semesters
Trimesters
Student will live:
Off-campus housing
University housing
At home with parents
Health Insurance:
Will you be covered
by your parents?
Y or N
If no, please check
type to the right.
Type 1: University health
insurance (charge must be listed
on university billing statement to
be covered by Foundation)
Type 2: Plan through third-party
provider (signed letter from university
with name of provider and cost for the
academic year, or other clear
documentation, required)
► Scholar signature ___________________________________________________________
Type 3:Plan through
an outside (nonuniversity) provider
Date ____________________
Scholar name
Last
First
MI
► INSTRUCTIONS FOR THE FINANCIAL AID OFFICE
 Complete the following information for the 2015-16 academic year (9-month budget). If your school does not use a 9-month
budget, complete the information below based on your school’s 2015-16 academic year and note the length of the academic
year on this form.
 Email or fax both pages of this form to the Foundation by July 1, 2015. Contact information is listed on page 1.
 List the actual expected expenses that your office relies on for awarding aid under Title IV.
 Retain a copy of this document for your files.
► 2015-16 Academic year (9-month) – Expenses (if not on a 9-month academic year, how long is the year?
)
1. Tuition (actual):
Full-time enrollment
Part-time enrollment
2. Required fees (actual) (not including medical coverage):
3. Health insurance (see bottom of page 1 – list $0 if the Scholar is obtaining health insurance
through an outside provider):
4. Books (estimate):
5. Room & board (see Scholar response to living situation on page 1 before responding):
Off-campus housing (estimate)
University housing (expected cost)
6. Additional approved expenses (should include personal and transportation estimates and any
other approved costs such as computer costs or child care expenses. Itemize the additional
expenses in the space below):
Personal/miscellaneous: $
Campus transportation/commute: $
___
Other: $
Other: $
Other: $
(describe
_______)
Do any of the above line items include expenses related to having dependents?
Yes No If yes, specify amounts in notes field or on a separate sheet.
$
$
$
$
$
$
Notes:
2015-16 Academic year (9-month) – Anticipated resources (excluding loans)
Amount
Name/description
a) $
1. Federal/state government grants:
b) $
a) $
2. Grants/scholarships from
institution:
b) $
a) $
3. Other grants/scholarships:
b) $
a) $
4. Expected family contribution
b) $
► Address for scholarship payment
►
Address:
City:
►
State:
Zip:
Certification of financial aid office: We certify that the above figures for expenses are correct to the best of our knowledge. If
submitting the form electronically, type your names in the signature lines and they will be considered official signatures.
Signature of financial aid officer (preparer):
Date:
Printed name and title:
Phone number:
Email:
Signature of financial aid director (required):
Printed name and title:
Date: