International Financial Questionnaire
International Financial Questionnaire
International Financial Questionnaire
QUESTIONNAIRE (IFQ)
This form must be completed by all international applicants for admission and
scholarship to Berea College.
For assistance with the completion and/or submission of this form, please
contact the Office of Admissions at 1.800.326.5948 or [email protected]
PERSONAL INFORMATION
1.
Ogbudu
Henrypat
Uche
Your Name _______________________________________________________________________
Last
First
Middle
2.
Please list the names of other colleges/universities to which you are applying
Nil
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
3.
Divorced
FAMILY INCOME
4.
5.
Family Employment Information: Include information for all that apply to you.
Name
Occupation
Employer
You
Agriculture
Ogbudu
Henrypat U. ____________________
Self
____________________
____________________
Father
Agriculture
Self
Ogbudu
Patrick I.
____________________
____________________
____________________
Mother
Stepfather
Stepmother
Guardian
Sponsor
Other
$ 2000 - 2500
What is your familys total annual income? US$_________________________________________
Does your family own a house? (if answering yes, please complete questions below)................................................. Yes
a. What year was it purchased?
8.
No
_______________
US$ _______________
c. How much does your family still owe on the purchase price?
US$ _______________
US$ _______________
US$ _______________
$ 655
of our customers who are yet to pay for the US$ _______________
d. Money owed to your family by others (please explain) Some
___________________________________________
US$ _______________
__________________________________________________________________________________________
$ 2755
US$ _______________
Do you or your family have money, property, or assets in another country? .................................................................... Yes
No
No
If yes, please list Make (e.g. VW, Fiat, Ford, Toyota, etc) and Year of Manufacture for each _____________
.
__________________________________________________________________________________________
FAMILY EXPENSES
11. Please list name, relationship to yourself, and age of all persons (including yourself) who depend on the income of your parents/
guardians for daily living expenses:
Name
Relationship
Age
Ogbudu Larrypat U.
____________________
Ogbudu
Tinapat N.
____________________
Ogbudu
Jerrypat I.
____________________
Ogbudu
Norapat
____________________
O.
Ogbudu
Jenny
____________________
Brother
18
_________________________
_____
Sister
_________________________
Brother
_________________________
Sister
_________________________
Grand
Mother
_________________________
12
_____
10
_____
7
_____
93
_____
Name
Relationship
Age
12. List all dependents that rely upon the family for educational costs:
Name
Name/Location of School
Micheal Okpara University,
Ogbudu Larrypat U. Umudike,
___________________
________________________
Abia, Nigeria
Amount of Institutional/
Amount provided by Family Govt Grant/Loan
$ 2,000
___________________
0
___________________
$ 2,000 - $ 2,500
0
____________________
_______________________
$ 810
$ 410
____________________
_______________________
$
810
$ 410
____________________ _______________________
$
810
$ 410
____________________ _______________________
___________________
____________________ _______________________
___________________
0
13. How many persons are financially dependent on you? Do not include yourself. ___________
0
___________________
0
___________________
Relationship
Age
Name
Relationship
Age
$ 300
US$ _______________
Two years ago, my father needed some money for surgery (Herniorrhaphy).
16. Why did the family borrow this money? (please explain) ____________________________________________________________________
The hospital bill was $625, but he had only about $90 then, so he borrowed $535 with 10% interest. So far, he has been gradually paying back
____________________________________________________________________________________________________________________
and hope to completely pay back before the end of next year.
____________________________________________________________________________________________________________________
No
_____________________
_____________________
____________________
b. Students assets
c. Familys income
_____________________
$ 500
_____________________
_____________________
$ 500
_____________________
____________________
$ 500
____________________
d. Familys assets
_____________________
_____________________
____________________
_____________________
_____________________
____________________
f. Your government
_____________________
_____________________
____________________
_____________________
_____________________
____________________
_____________________
_____________________
____________________
_____________________
_____________________
____________________
19. Please list all agencies, foundations, and government grants/scholarships for which you are applying. Use additional sheet(s) if necessary.
Agency/Foundation/Government
_________________________________________________
________________________________________
US$ __________________
_________________________________________________
________________________________________
US$ __________________
_________________________________________________
________________________________________
US$ __________________
_________________________________________________
________________________________________
US$ __________________
20. Excluding support listed above, how will you pay for transportation costs to Berea College, Berea, Kentucky (airfare, bus fare, etc.)?
____________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________
21. Documentation must be provided to verify income and asset information listed on this form. Please indicate the type of documentation
you are providing: Tax Forms
____________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________
22. You will be required to make a deposit of $2,200 if you are offered admission to Berea College. This deposit will be used during your
four years at Berea College to defray any emergency expenses you may have. The balance will be returned to you upon graduation.
Family's Savings
What source of funds will you use to make this deposit? ___________________________________________________________________
06/12