APPLICATION FORM FOR SCHOLARSHIP FOR THE SCHOOL YEAR 2011 / 2012

DEADLINE FOR SUBMISSION OF APPLICATION: FEBRUARY 28TH, 2011

This application form, with all documents and materials attached, should be sent in a sealed envelope addressed to:
Scholarship Fund Committee
Rome International School
Via Panama, 25
00198 Rome

PART I FAMILY INFORMATION (Please Print or Type)

1. Family situation

First name

Family name

Relation to children

Employer

Nationality

Parent 1:
Parent 2:
Type of Family (1)

(1) Please answer Yes or No

New Family at RIS _____

Family returning to RIS ______

2. Where can we contact you, if more information is needed?

Parent 1:
E-mail address ___________________________________________
Home number ____________________________________________
Mobile
____________________________________________
Parent 2:

E-mail address ___________________________________________

Home number ____________________________________________
Mobile
____________________________________________

3. Child for whom you are requesting Scholarship

First Name and family name
Child

________________________________________

Scholarship granted in school year 2010/2011

Date of Birth
________________
Yes ________

No ________

Grade applied to

Nationality

__________

___________

Passport no.

4. All other dependent children except the student for whom you are requesting a Scholarship
Name
________________
Name
________________
Name
________________

Age

School/College name

____

___________________

Age

School/College name

____

___________________

Age

School/College name

____

___________________

Fin. Aid (1)

_________
Fin. Aid (1)
_________
Fin. Aid (1)
_________

Cost (2)
________
Cost (2)
________
Cost (2)
________

(1) Does your child receive a financial aid? Please answer Yes or No. If Yes please indicate the percentage and attach to this form a statement from the school/college detailing the amount of the fees and the financial aid granted.
(2) Total cost of this schooling paid by you or by your employer during the school year. Please fill in NONE if there are not costs.

5. Intended period of stay in Rome

How long will you be staying in Rome ? ___________ academic year(s) (1)
Comment (if needed) .
Will you be applying for the scholarship in subsequent years? ________ (2)
(1)
(2)

Please fill in the number of academic years that you estimate to stay in Rome
Please answer Yes or No

PART II REASON FOR APPLICATION AND FORECAST

Please explain why your child need English speaking international education.
The following questions might help you: Have your child been in an International School before? How long is your family going
to stay in Italy? Does your child have special learning needs? In which languages is your child fluent?
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If there are any other factors which should be considered in your case, please write the information on a separate sheet of paper and attach it to this form.

PART III - ASSETS AND LIABILITIES

This statement must include all assets and income for all members of the household and dependents.
Please convert all currencies to Euro at the current rate of exchange.
ASSETS EUR
1. Cash on hand in bank (savings and current) ............................................
2. Stocks, bonds, and other securities ............................................
3. Home if owned (current value estimate) ............................................
4. Other assets such as real estate, business, farm, etc.
Please give details of these other assets and indicate current value
.............................................................................................. ............................................
.............................................................................................. ............................................
TOTAL ............................................
LIABILITIES (1) EUR
1. Home mortgage (total) ............................................
2. Other loans or liabilities (total). Please give details of these other loans & liabilities
.............................................................................................. ......................................
.............................................................................................. ......................................
(1) Please indicate if Monthly/Quarterly/Yearly

PART IV - ANNUAL INCOME Yearly Net income in EUR

1. Net salary Parent 1 ............................................
2. Net salary Parent 2 ............................................
3. Income from securities/bonds ............................................
4. Income from rental property ............................................
5. Other income (please describe) ....................................... ............................................
.............................................................................................. ......................................
TOTAL ............................................

PART V - BENEFITS IN KIND

1. Educational allowance paid by employer or any other financial source for the scholastic year applied to: Yes ___No ___.
If Yes, how much? ...................................... EUR
2. Housing provided by employer: Yes ___ No ___
3. Company Car: Yes ____ No ____
4. Other Benefits in kind (please indicate nature and amount)
.............................................................................................. ...................................... EUR
.............................................................................................. ...................................... EUR

PART VI - OTHER INFORMATION

Please enclose copies of the following documents:

1. for each income earner
(a) Salary slips for the past 6 months
(b) Most recent annual statement of income tax paid
(c) If self-employed, your most recent annual accounts
(d) Copy of passport
2.

A statement from your employer detailing the amount of the tuition fees that they pay. If they pay nothing, a statement to this effect is required

3.

for the child you are asking the scholarship

(a) school report for the past 2 years
(b) vaccine record
(c) an official document (issued by a public authority) specifying the number of family members

If these documents are not enclosed, the Scholarship Committee will not be able to consider your application

We declare that all the information supplied is true and correct and includes all incomes and benefits in kind. We are aware of being obliged to notify the Scholarship Fund Committee of any
changes in family income.
Signed
Parent 1 ...............................................................
Parent 2 ...............................................................

Please return this form under confidential cover to:

Date ......................................