Yale University Student Financial Services

http://www.yale.edu/sfas/financial.html

Student Financial Services P.O. Box 208288 New Haven, CT 06520-8288

Phone: (203) 432-2700 Fax: (203) 777-6100

2013-2014 International Noncustodial Parent Statement

Students Name: _________________________________________ Yale I.D. Number: __________
First Middle Last

Address: _______________________________________________ Date of Birth: _____________ Noncustodial Parents (and Current Spouses) Information
Students Noncustodial Parent Name Address Occupation Title Employer Information Employer Name: Number of Years with Employer: Employer Name: Number of Years with Employer: Age: Noncustodial Parents Current Spouse (if any) Age:

What is the current exchange rate of your countrys currency to the U.S. Dollar? _________________ = $1.

Noncustodial Parents Dependent Information

Provide the following information for others who depend on your income for daily living expenses. Name Relationship Age

Complete the section below for any of the above persons who depend on you for their educational costs. Students Name Name/Location of School Annual Cost to Attend Amount that You Provide Amount of Aid from Institution/ Government

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Noncustodial Parents (and Current Spouses) Income Information

List familys total annual income in U.S. dollars. Source of income Noncustodial Parent Noncustodial Parents Spouse Other Total Actual 2011 Income US$ US$ US$ US$ Actual 2012 Income US$ US$ US$ US$ Estimated 2013 Income US$ US$ US$ US$

Explain income from other sources here: The primary source of family income is from: Salary/Wages Family Owned Business/Farm Other (explain below)

Noncustodial Parents (and Current Spouses) Asset and Debt Information

Complete the following information about the present value of assets or jointly owned assets. Land and Buildings (Other than Home) Money Owed to Family by Others Explanation: Does your family own its home? Year of Purchase US$ Yes US$ US$ US$ Savings and Investments Other Assets Explanation: No If yes, complete the following. Amount Still Owed on Purchase Price Present Sale Value US$ US$ US$

Original Purchase Price

Noncustodial Parents (and Current Spouses) Expenses

List average amounts of money spent each year by your family for the following expenses. Food Clothing Housing (Rent or Mortgage Payments) Taxes List and explain any other expenses: US$ US$ US$ US$ Utilities Medical Expenses Automobile Maintenance Child Support US$ US$ US$ US$

Certification
I declare that the information on this form is true, correct, and complete. If requested, I agree to provide documentation to verify information reported. Noncustodial Parents Signature: __________________________________________ Date
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