IELPO Scholarship application form
1. PERSONAL INFORMATION
Last Name:
First Name:
Application Number:
How did you finance your undergraduate studies?
( ) Scholarship
( ) Loan
( ) Parents
( ) Others (please, specify):
( ) Working
How did you finance your postgraduate degree, if any?
( ) Scholarship
( ) Loan
( ) Parents ( ) Working
( ) Others (please, specify):
Are you financially dependent on your parents?
( ) YES
( ) NO
If the answer is NO, please explain below what your sources of financing are
and indicate in the corresponding box if you have relatives who depend on
you:
Relationship
Date of birth
My sources of financing are:
If your answer is YES, please answer the following question: Do you have
brothers or/and sisters or any other relative who financially depend on your
parents?
( ) YES
( ) NO
Relationship
Date of birth
2.- FINANCIAL INFORMATION
If you depend on your parents:
Father
Annual gross income:
Annual taxable income:
Occupation and name and address of the employer:
Mother
Annual gross income:
Annual taxable income:
Occupation and name and address of the employer:
If you do not depend on your parents:
Your current annual gross income:
Your current annual taxable income:
Spouse
Annual gross income:
Annual taxable income:
Occupation and name and address of the employer:
Have you requested financial assistance to other organisations?
( ) YES:
Scholarship:
Organization:
Loan:
Bank/Organization:
( ) NO
3.- REQUEST FOR FINANCIAL AID
(you can tick more than one box)
Full Scholarship ( )
Partial Scholarship:
covering the 33% of the tuition fees ( )
covering the 50% of the tuition fees ( )
covering the 75% of the tuition fees ( )
Statement of not more than 300 words explaining the reasons why you want to
apply for financial aid:
STUDENTS’S DECLARATION
I certify that the above statements are accurate. If they were not, it could
involve the withdrawal of the financial aid and the refund of the part of
scholarship already received.
Date