9) Were you ever considered an independent student for financial aid purposes during the course of undergraduate study?
□ YES □ NO
You must provide information about your (and your spouse’s) assets. If you are divorced or separated and you and your spouse have
jointly owned assets, give only your portion of the assets and debts. Be sure to give information about assets held in trust for you (and
your spouse). If you (and your spouse) have assets owned jointly with someone else --such as a business or farm --give only your (and
your spouse’s) portion of the assets and debts. Indicate any non-applicable information with N/A.
1) Marital Status: □Single, Divorced, or Widowed □Married □Separated Total # in household: ______
2) Total current balance of cash, savings, and checking accounts: $
3) What is the current net worth of investments (current value minus debt): $_______________________
Investments include real estate (do not include the home you live in), trust funds, UGMA and UTMA accounts, money market funds,
mutual funds, certificates of deposit, stocks, stock options, bonds, other securities, education IRAs, college savings plans, installment
and land sale contracts (including mortgages held), commodities, etc. Investment value includes the market value of these
investments as of today. Investment debt means only those debts that are related to the investments. Investments do not include the
home you live in, cash, savings, and checking accounts, the value of life insurance and retirement plans (pension funds, annuities,
non-education IRAs, Keogh plans, etc.) or the value of prepaid tuition plans.
4) What is the current net worth of business and/or investment farms (current value minus debt): $____________________
Do not include a farm you live on and operate or a small family business if your family controls more than 50% of the business and
the business has 100 or fewer full-time or FTE employees. Business and/or investment farm value includes the market value of land,
buildings, machinery, equipment, and inventory etc. Business and/or investment farm debt means only those debts for which the
business or investment farm was used as collateral.
1) Do you plan to work (excluding College Work-Study) while enrolled in the MSW Program? □ YES □ NO
Hrs./week________ Approx. gross earnings/month: $
2) Spouse’s/Partner’s anticipated gross earnings per month: $
3) Will you receive financial assistance or have any other anticipated sources of income (i.e., parental/family support, employer
reimbursement, teaching or research assistantships, government benefits, etc.)?
□ YES □ NO
If yes, please specify type, amount, and duration: _____________________________________________________________
4) Have you informed the UM Office of Financial Aid (OFA) of all tuition/scholarship assistance? Please note that you are
legally required to report all tuition/scholarship support to OFA.
□ YES □ NO, but plan to
5) List the names and ages of any dependents: _________________________________________________________________
6) Estimate monthly childcare expenses (if any) during full-time enrollment (8-month period) : $
7) Estimate outstanding monthly medical expenses (if any) not including the cost of health insurance: $
8) Balance still owed on your federal educational loans from undergraduate and/or graduate education: $
It is Your Responsibility to Inform the School of Social Work of Any Changes in Resources.
If you have unusual circumstances/additional comments regarding your financial situation, or would like to explain/provide more
information on your answers above, please do so here. Any information provided will be used only for SSW grant/scholarship
consideration, including special programs..
I certify that all information submitted on this form is complete and correct. I understand that misrepresentation of any portion
of this application, including supporting documents, may be cause for canceling my admission or financial aid award. I also
understand that all documents that I submit become the property of the University of Michigan.
Signature (check to sign) Date