Escondido Family Fund Application Form

Fill out the following form to apply for support from the Escondido Family Fund.

Your Contact and Personal Information

Name: *

Your full name

Gender: *

Female

Male

Email Address: *

Campus Address (in Escondido Village): *

Home Telephone: *

Work Telephone:

Student ID Number: *

Citizenship Status: *

Marital Status: *

Your Degree Program

Department or School: *

Date of Matriculation: *

Degree Program: *

Use the degree program to which you were admitted; for example, if you were admitted to a Ph. D. program but are now pursuing a Master's, use Ph. D.

Date Degree is Expected: *

Estimates are fine.

Your Spouse/Partner and Family

Spouse's/Partner's Name (if applicable):

Spouse's/Partner's Employer/School:

If your spouse/partner is also a Stanford student, indicate which school or department.

List your children's names and ages (if applicable):

Financial Data

If a particular field in this section doesn't apply to you, enter 0.

Please indicate how you will be entering your financial data (except where noted otherwise): *

Annually

Monthly

Expenses

Rent: * $

Food: * $

Household: * $

Examples: utility bills, cleaning supplies, shared household items

Telephone: * $

Medical Bills/Copays and Health Insurance: * $

Dental costs (unreimbursed): * $

Dental costs above and beyond what's covered by your insurance

Childcare (program or in-home): * $

Personal : * $

Toiletries, entertainment, etc.

Education Loans: * $

Auto Loans: * $

Other Loans: * $

Tuition: * $

Books: * $

Academic Supplies: * $

Examples: a specific laptop required by your program, software, etc.

Other Education Expenses: * $

Examples: conference fees, copying fees for your dissertation, etc.

Total Yearly Expenses: * $

Total Expenses Per Month: * $

Resources

Fellowships: * $

Assistantships: * $

Grants: * $

Loans: * $

Personal Monthly Earnings: * $

Spouse's/Partner's Monthly Earnings: * $

Financial Contributions from Other Sources: * $

Example: money from parents or other relatives

Other Assets: * $

Total Resources Per Year: * $

Total Resources Per Month: * $

Loan Debt

Add up all your loan debt--student loans currently in deferment, plus any loans you are paying now that you listed in "expenses."

Total Loan Debt: * $

Please explain your reasons for requesting assistance from the Escondido Family Fund: *

Regular Appointments:
(650) 736-7078
24/7 Crisis Assistance Pager:
(650) 723-8222 Ext. 25085

Concerned about a grad student you know?

Learn how GLO can help.

Escondido Family Fund Application Form

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