Stanford EXPLORE



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FINANCIAL AID APPLICATION (SUMMER 2019):

There exists limited financial aid that will be offered in the form of partial scholarships (up to half of the cost of tuition), and in some cases full scholarships (generally for full scholarships, families earning less than $80,000 gross adjusted income are encouraged to apply). Aid is granted based on financial need and merit. Students must apply for this financial aid by mailing in this application form. Decisions will be emailed to you within 2 weeks.

Please mail the completed application to Stanford EXPLORE (FA), 269 Campus Drive; Mail Code: 5166; Stanford, CA 94305

THIS SECTION SHOULD BE FILLED OUT BY THE PARENTS:

PERSONAL DATA:

1) Name of student: ____________________________________________________

2) Name of person completing this form and relationship to student/email/phone #:

___________________________________________________________________

PARENTS’ INCOME AND EXPENSE INFORMATION:

4) Total gross family income (annual)--Include income for all family members before deductions. This includes wages, interest, dividends, unemployment benefits, welfare

payments, social security, child support, etc.: _________________________________

5) Number of dependents listed on federal tax return: children _____; adults ______

6) Are any of the student’s siblings currently in college? Yes ______; No______

If yes, what is the current tuition that you are paying? __________________

7) At any time in the past year did the student or the student’s parents receive benefits from any of the following federal programs: SSI, food stamps, free or reduced lunch, TANF, or WIC?

Yes _____ ; No _____; If yes, which program(s)?_____________________________

8) Are either of the student’s parents self-employed? Yes _____; No_____

9) Does either parent own all or part of a business? Yes _____; No _____

10) What is the student’s parents’ housing status? Rent ____; Own ____; Other ______

11) If parents own the home, what is the current market value of the home? _________________; How much is currently owed on the home? _________________

ADDITIONAL INFORMATION:

Please indicate the maximum amount of the program fee that you are able to pay in order to send your child to the EXPLORE program: __________________________

Please use the area on the back to provide any other relevant information you would like the Financial Aid Committee to have regarding your application for aid, such as financial hardships or special circumstances.

I verify that the statements in this application are true.

Parent Signature: ________________________________________ Date: _________________

THIS SECTION SHOULD BE FILLED OUT BY THE STUDENT:

Personal Information:

|Name: __________________________________________________________ |

|Last First Middle |

|Street Address: |

|City, State, Zip Code: |

|Home Phone #: ( ) Cell Phone #: ( ) |

|Email Address: |

|Gender: M_____ F_____ |

|Date of Birth: |

|Are you a U.S. Citizen or Resident Alien? Yes_____ No______ |

Parents/Guardian Information:

|Name: __________________________________________________________ |

|Last First Middle |

|Name: __________________________________________________________ |

|Last First Middle |

|Street Address: (if different from above) |

|City, State, Zip Code: |

|Phone Number: ( ) Cell phone #: |

|Email Address: |

|Have your immediate family members (mother, father, siblings) attended college? |

|____yes ____no |

|Parent or Guardian’s Education Level (highest degree attained): |

|Mother/guardian: ____________________ Father/guardian: ___________________ |

High School Information:

|School currently attending: |

|City, State: |

|Current grade in high school: ____________ Expected year of graduation __________ |

|Most Recent Cumulative GPA: weighted _________ ; unweighted _________ |

Test Scores (if taken….these are not required):

|SAT I- date taken/score(s): |

|SAT II- date taken/score(s): |

|PSAT- date taken/score(s): |

|Other tests- date taken/score(s): |

|Will you require a parking permit? Yes _____ No _____ |

|Will you be commuting by bus/train? Yes _____ No______ |

|Will you be dropped off/picked up by a parent? Yes_____ No ______ |

|Race (For Statistical and Reporting Purposes only): |

|Caucasian ____ African-American ____ Asian/Pacific Islander (please specify) ____________ |

|Hispanic ____ Native American/Alaska Native ____ Other (please specify)______________ __ |

Please list all the science and math courses you have completed or are currently taking and include the letter grade you have received per class:

Course Name Grade Received

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How did you find out about the EXPLORE Program?

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

ESSAY:

Please write a 1 page essay (single spaced) describing why you are interested in taking the Stanford EXPLORE Lecture Series.

I am interested in attending the following weeks (SUMMER 2019):

___ Week 1: July 8-12 Immunology/Neuroscience

___ Week 2: July 15-19 Stem Cell/Cardiovascular Medicine

___ Week 3: July 22-26 Bioengineering/Bioinformatics/Genetics

___ Week 4: July 29- August 2 Cancer/Careers in Science and Medicine

I verify that the statements in this application are true.

__________________________________________ ______________

Student Signature Date

__________________________________________ ______________

Parent Signature Date

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