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									                                            International House
                     Room and Board Financial Aid Program
                                               Spring Semester 2012
                                     Application Instructions
                Applications for room and board financial aid are available to graduate or upper division registered
    international students, US citizens and permanent residents who have demonstrated financial need and meet all
    other qualifications.

                The purpose of the financial aid program is to offer UC Berkeley students who demonstrate financial
    need an opportunity to experience first hand cultures from all over the world while enabling international students
    to learn about the ethnic and economic diversity in the United States. To be considered for financial assistance, an
    applicant must have completed two semesters of study at UC Berkeley and meet the following criteria:

      Spring 2012 semester applicants must have been registered spring 2011 and fall 2011.
      Full-time upper division or graduate standing
      Demonstrated financial need
      Provide FAFSA Student Aid Report (domestic students). Please allow three days for processing.
      U.S. citizens and permanent residents
      Non-immigrant student status F1 or J1 (international students)
      GPA must be 3.0 or higher (very special circumstances considered)
      Provide an unofficial copy of your transcript
      Preference will be given to student applicants who are close to completing their study
      Preference will be given to applicants demonstrating high academic achievement who have not received
         International House financial assistance in the past two years.

    If you are interested in applying for financial assistance, please complete this application, available at Incomplete and illegible applications will not be considered.

                             submit your completed application
                      Please Please submit your completed application to: by email to:

International Students: Josiane Siegfried,, 510 642-2196
U.S. Students and Permanent Residents: Ryan Jones,,510 642-9470

                      Application Deadline: Monday, October 17, 2011, 4:30 p.m.
                            International House * 2299 Piedmont Avenue * Berkeley, CA 94720
                                         Visit our website:

Domestic Students Only: The FAFSA process takes three days to complete. Please apply for your FAFSA
early, as it must be included with your completed application by October 17.

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                                      Additional Information
                                         Please read the following carefully.

Applications are pre-screened to select UC Berkeley students who closely fit the guidelines. Applicants will
be contacted after the deadline for application status. International House reserves the right to seek comparable
information from campus departments, the Berkeley International Office or other appropriate sources. Be sure to
indicate a day phone number on your application.

The International House Board of Directors’ Financial Aid Committee, chaired by the Assistant Dean of Graduate
Division, makes award selections. Applicants will be informed, by e-mail, regarding the status of their application.

It is the longstanding policy of International House that any student with an unpaid balance to International House
for room and board is not eligible to receive room and board financial aid.

You are required to accept and pay your advance deposit within two weeks of receiving your International House room
and board license contract. Otherwise, your award will be forfeited.

Financial Aid awards consist of full or partial payment of room and board fees at International House. This
includes regular double room occupancy for undergraduate students, and regular single rooms for graduate
students. Because Bay view rooms are considerably more expensive than regular single rooms, it is the established
policy of I-House that students who receive International House room and board financial aid or Gateway
Fellowships are not eligible to live in single rooms with Bay views.

We cannot make the Financial Aid awards without a social security number or an ITIN number. If you do not already
have either, you will need to apply as soon as possible. Please check with the Berkeley International Office
( or go to for more information on how
to obtain a social security number or an ITIN number.

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                 International House Room and Board Financial Aid Application
                                      Spring Semester 2012

Application Deadline:
                                 For Spring 2012: 4:30 p.m., Monday, October 17, 2011

                                                Please type or print neatly

                                                   I. PERSONAL INFORMATION

         Family Name                          First Name                                  Middle
____________________                 _________         ___________       _____/_____/______
Student ID Number                    Visa Status         Alien #             Date of Birth

Local Address: ___________________________________________________________________________________
                        Street                  City                       Zip Code
Permanent Address:________________________________________________________________________________

Telephone: (_____) _______-____________Message Phone: ___________________ E-mail:_____________________
                                                                                                   (Print Neatly or Type)
□ Male            □ Female                    Ethnicity/Nationality: _________________________ (For statistical purposes only)

Country of Birth _______________________________                Country of Citizenship: ______________________________

How did you hear about this program? □ Daily Cal □ Department flyer □ Other_____________________________
Have you previously lived at I-House? □ Yes □ No If yes, what year: _________
Have you ever received an I-House Room and Board Award? □ Yes □ No If yes, what year: ________
Do you pay out-of-state tuition? Yes____ No_____
Are you a Returned Peace Corps volunteer? Yes____ No_____


Have you been continuously registered at UC Berkeley for Spring Semester 2011 and Fall Semester 2011? _______
If no, please explain:
□ Undergraduate (□ Junior    □ Senior)                 □ Graduate     GPA: ______ Total credits earned: __________
Degree Program               Major/Field of Study (Do NOT abbreviate)         Expected Completion Date

If you are a master's student:       Plan to continue for a Ph.D. at Berkeley?   □ Yes    □ No     Directly?      □ Yes         □ No

If you are a Ph.D. student: Date advanced to Ph.D. candidacy: ___/___/____                Degree completion date: __/___/___

Name of academic advisor______________________________                   Telephone:       (_____)________-______________

List all colleges and universities you have attended, including the University of California at Berkeley:

       Name of College                         Address                      Dates of Attendance        Degree Received and
        or University                                                                                     Date Received

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                              Be sure to list expenses and resources based on Spring 2012

                                               Every Question Must be Answered

                                            III. PERSONAL RESOURCES

Total funds deposited in all bank and market accounts in the US and abroad:
How much of the above can you spend for school for the academic year and why?
What type of car do you own? Model:__________Year ______Name of registered owner_____________________
        Information may be verified.
Please state other personal income: _______________________________________

TOTAL PERSONAL RESOURCES                     (Add starred items only)

                               IV. FAMILY/RELATIVES/SPONSOR RESOURCES

Are you the main provider?:    □ Yes □ No If yes, go to Section V. If no, please answer all questions in Section IV.

__________________________          _________________________            _____________ $________.____
Name of main provider of funds             Occupation                      Relationship Annual Family Income

Total family funds in all bank and market accounts in US and abroad:                              $_________.____

Annual income from assets such as: property, stock, business interest, etc.                       $_________.____
Number of children supported by family income:                                                    $_________.____

Amount of support you received last year:                                                         $_________.____

Please indicate support you EXPECT to receive from your family, relatives or sponsors during the academic year:

___________________________                  _________________________          $_______________.____
Name of relative who provides support                Occupation                   Amount of Support
_______________________________              _________________________          $_______________.____
Name of relative who provides support                Occupation                   Amount of Support
___________________________________ _________________________                   $_______________.____
Name of sponsor that provides financial or other support      Address              Amount of Support

TOTAL EXPECTED FAMILY/RELATIVES/SPONSOR RESOURCES                                                 $_________.____

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                                         V. INTERNAL/EXTERNAL RESOURCES

The purpose of the financial aid program is to assist you to meet your financial and educational goals. It is important to
                        show all financial resources to help us determine your financial need.

     Type and Number of         Applied     Expected                 Name                    Semester(s)           Amount
                                  #             #
  Scholarship(s)     _____
                                  □ __        □ __                                             O Su O F        $
  Fellowship(s)      _____
                                  □ __        □ __                                             O Su O F        $
  GSI                _____
                                  □ __        □ __                                             O Su O F        $
  GSR                _____
                                  □ __        □ __                                             O Su O F        $
  Department Grant   _____
                                  □ __        □ __                                             O Su O F        $
  Nonresident Tuition Waiver
                                  □ __        □ __                                             O Su O F        $
  Fee Remission      _____
                                  □ __        □ __                                             O Su O F        $
  On-Campus Work     _____
                                  □ __        □ __                                             O Su O F        $
  Off-Campus Work _____
                                  □ __        □ __                                             O Su O F        $
  Loans              _____
                                  □ __        □ __                                             O Su O F        $
                                  □ __        □ __                                             O Su O F        $
                                  □ __        □ __                                             O Su O F        $

Total Loan Balance to date: $____________________________


United States Government (agency and amount)           _______________________________              $_________.____
Foreign Government (name and amount)                   _______________________________              $_________.___

Other organization/agency (name and amount)            ________________________________             $_________.____
Any other source (describe nature, name, and amount):
_________________________________________________________________________                           $_________.____

TOTAL INTERNAL/EXTERNAL RESOURCES                                                                   $_________.____

Please feel free to provide additional information regarding your resources. If you have pending scholarship
applications or offers, you should mention them as well.

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                                          VI. ESTIMATED STUDENT BUDGET
                           Be sure to list expenses and resources based on Spring Semester 2012

Expense Category                   Projected Expenses                               RESOURCES
                                   (Spring 2012)
                                                         III. Your Personal Resources
Tuition and Fees                       __________        $_______.____
 Books and Supplies                    ___$650___
                                                         IV. Family/Relative/Sponsor Resources $_______.____
 Housing                               __________
                                                          V. Internal/External Resources
 Utilities (phone, etc.)               ___$400___        $_______.____

 Food                                  __________

 Travel (itemize)                                               TOTAL RESOURCES
 _____________________                                   $_________.____
 _____________________                 __________
 Transportation (local)                                                 CURRENCY INFORMATION
 _____________________                 __________        Amount of support received in foreign currency __________.___

 Medical/Dental (itemize)                                The current exchange rate between foreign currency and US dollar is
                                                         $1.00 = ______________________
(Not covered by insurance)
  _____________________                                  Are there currency exchange restrictions on sending money out of your
  _____________________                __________        country? □ Yes □ No.

                                                         If yes, have you applied for an exchange permit?
 Personal Expenses (itemize)                                     □ Yes □ No
(Maximum $1,125 per
semester)                                                If no, why not?__________________________________________
  _____________________                                  ______________________________________________________
  _____________________                                  ______________________________________________________
  _____________________                __________

                                                         Total Resources                       $_________.____

                                                         Total Expenses                         $_________.____
                                                                     ESTIMATED FINANCIAL NEED:
                                                                       (Total Resources minus Total Expenses)

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                                                      VII. PERSONAL STATEMENT
The personal statement is a very important part of the review process.

          A) Part I: Essay

1. Please discuss your reasons for wanting to live at International House. Please mention what you want to contribute,
   accomplish and take away with you.

2. Please describe any special circumstances that you want the Financial Aid Program Committee to consider in
   reviewing your application.

3. How has your financial situation changed since you started at UC Berkeley?

Please attach your 1-2 page response to the above questions.

          B) Part II: Summary

     1.   In addition to the 1-2 page essay, please also attach a 1-2 paragraph summary of your essay.

                                                              VIII. STATEMENT

Please read and sign the following statement:

I understand that financial aid depends on adherence to International House rules for residents and the University’s
Code of Conduct. Any violation of these rules may lead to disciplinary action, including termination of residence and
withdrawal of the entire room and board financial aid grant. I further understand that upon violation of such rules and
the University’s Code of Conduct, I will be responsible for reimbursement to International House the amount of the
grant that was applied towards room and board fees from the time of move-in until the time of any premature
termination of the room and board contract.

I hereby certify that to the best of my knowledge all information furnished in this application is complete and correct. I
agree to notify the Financial Aid Program Coordinator at International House in writing and within ten days of any
change in my financial situation that involves the receipt of $500 or more income or other financial resources than
projected in this application. I will provide, if requested, official documentation, including income tax returns, necessary
to verify information provided in this application.

_____________________________________________________________                                        _____/_____/______
              Signature                                                                                      Date

H:\Executive\WORDDOC\SCHOLARS\application Spring 2012 rev. 6-27-11

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