INTERNATIONAL FINANCIAL

QUESTIONNAIRE (IFQ)
This form must be completed by all international applicants for admission and
scholarship to Berea College.
For assistance with the completion and/or submission of this form, please
contact the Office of Admissions at 1.800.326.5948 or askadmissions@berea.edu

PERSONAL INFORMATION
1.

Ogbudu
Henrypat
Uche
Your Name _______________________________________________________________________
Last
First
Middle

2.

Please list the names of other colleges/universities to which you are applying

Nil
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
3.

Marital Status of Parent(s): Please check only one.

 Married

 Divorced

 Father living, Mother deceased

 Mother living, Father deceased

 Other (explain) __________________________________________________________________

FAMILY INCOME
4.

5.

Family Employment Information: Include information for all that apply to you.
Name
Occupation
Employer
You

Agriculture
Ogbudu
Henrypat U. ____________________
Self
____________________
____________________

Father

Agriculture
Self
Ogbudu
Patrick I.
____________________
____________________
____________________

Mother

____________________ ____________________ ____________________

Stepfather

____________________ ____________________ ____________________

Stepmother

____________________ ____________________ ____________________

Guardian

____________________ ____________________ ____________________

Sponsor

____________________ ____________________ ____________________

Other

____________________ ____________________ ____________________

The primary source of family income is from:  Salary/Wages

 Family-owned business or farm

 Other (explain) __________________________________________________________________

6.

$ 2000 - 2500
What is your familys total annual income? US$_________________________________________

Office of Admissions | CPO 2220 | Berea, KY 40404 | askadmissions@berea.edu

International Financial Questionnaire (IFQ)

FAMILY ASSETS
7.

Does your family own a house? (if answering yes, please complete questions below).................................................  Yes
a. What year was it purchased?

8.

 No

_______________

b. What was the original purchase price?

US$ _______________

c. How much does your family still owe on the purchase price?

US$ _______________

d. What is the present sale value?

US$ _______________

Give present value of other family assets:

$ 1100
US$ _______________
$ 1000
US$ _______________

a. Land and building (other than home)

b. Savings
c. Investments (such as stocks and bonds)

US$ _______________
$ 655
of our customers who are yet to pay for the US$ _______________
d. Money owed to your family by others (please explain) Some
___________________________________________

supplies we made to them

__________________________________________________________________________________________
e. Other (please explain) _______________________________________________________________________

US$ _______________

__________________________________________________________________________________________

$ 2755
US$ _______________

TOTAL of items 8a-8e

9.

Do you or your family have money, property, or assets in another country? ....................................................................  Yes

 No

a. If yes, in which countries are these assets held? _________________________________________________

b. List the assets, and their value in U.S. dollars: ___________________________________________________
__________________________________________________________________________________________
10. Does the family own automobiles? ................................................................................................................................  Yes

 No

If yes, please list Make (e.g. VW, Fiat, Ford, Toyota, etc) and Year of Manufacture for each _____________
.

__________________________________________________________________________________________

FAMILY EXPENSES
11. Please list name, relationship to yourself, and age of all persons (including yourself) who depend on the income of your parents/
guardians for daily living expenses:
Name

Relationship

Age

Ogbudu Larrypat U.
____________________
Ogbudu
Tinapat N.
____________________
Ogbudu
Jerrypat I.
____________________
Ogbudu
Norapat
____________________
O.
Ogbudu
Jenny
____________________

Brother
18
_________________________
_____

______________________________ ____________________ _____

Sister
_________________________
Brother
_________________________
Sister
_________________________
Grand
Mother
_________________________

______________________________ ____________________ _____

12
_____
10
_____
7
_____
93
_____

Name

Relationship

Age

______________________________ ____________________ _____

______________________________ ____________________ _____
______________________________ ____________________ _____

12. List all dependents that rely upon the family for educational costs:
Name

Name/Location of School
Micheal Okpara University,
Ogbudu Larrypat U. Umudike,
___________________
________________________
Abia, Nigeria

Annual cost to attend

Amount of Institutional/
Amount provided by Family Govt Grant/Loan
$ 2,000
___________________
0
___________________

High School, Abia

Ogbudu Norapat O. Evangel
___________________
________________________

$ 2,000 - $ 2,500
0
____________________
_______________________
$ 810
$ 410
____________________
_______________________
$
810
$ 410
____________________ _______________________
$
810
$ 410
____________________ _______________________

___________________

____________________ _______________________

___________________

Ogbudu Tinapat N. Evangel

High School, Abia
___________________
________________________

Ogbudu Jerrypat I. Evangel

High School, Abia
___________________
________________________
________________________

0
13. How many persons are financially dependent on you? Do not include yourself. ___________

0
___________________
0
___________________

International Financial Questionnaire (IFQ)

14. For each of your dependents, complete the following information:
Name

Relationship

Age

Name

Relationship

Age

____________________ _________________________ _____

______________________________ ____________________ _____

____________________ _________________________ _____

______________________________ ____________________ _____

$ 300
US$ _______________

15. How much money does your family owe to others?

Two years ago, my father needed some money for surgery (Herniorrhaphy).
16. Why did the family borrow this money? (please explain) ____________________________________________________________________
The hospital bill was $625, but he had only about $90 then, so he borrowed $535 with 10% interest. So far, he has been gradually paying back
____________________________________________________________________________________________________________________
and hope to completely pay back before the end of next year.
____________________________________________________________________________________________________________________

17. Does the family employ other people? ........................................................................................................................... Yes

 No

a. If yes, how many people are employed in the home? ____________________________________________

b. If yes, how many people are employed in the family business? ____________________________________

RESOURCES TO COVER COLLEGE EXPENSES

18. How much support will you receive each year (every 12 months) from the following for your part of room, board, fees, and personal
expenses. Express all amounts in U.S. dollars.
First year of enrollment

Second year of enrollment

Third year of enrollment

a. Students summer wages

_____________________

_____________________

____________________

b. Students assets
c. Familys income

_____________________
$ 500
_____________________

_____________________
$ 500
_____________________

____________________
$ 500
____________________

d. Familys assets

_____________________

_____________________

____________________

e. Relatives and Friends

_____________________

_____________________

____________________

f. Your government

_____________________

_____________________

____________________

g. Agencies and Foundations

_____________________

_____________________

____________________

h. Sponsor (explain below)

_____________________

_____________________

____________________

i. Other (explain below)

_____________________

_____________________

____________________

Explanation for 18h and/or 18i: _____________________________________________________________________________________

_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________

19. Please list all agencies, foundations, and government grants/scholarships for which you are applying. Use additional sheet(s) if necessary.
Agency/Foundation/Government

Award Notification Date

Expected Award Amount

_________________________________________________

________________________________________

US$ __________________

_________________________________________________

________________________________________

US$ __________________

_________________________________________________

________________________________________

US$ __________________

_________________________________________________

________________________________________

US$ __________________

International Financial Questionnaire (IFQ)

20. Excluding support listed above, how will you pay for transportation costs to Berea College, Berea, Kentucky (airfare, bus fare, etc.)?
____________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________

21. Documentation must be provided to verify income and asset information listed on this form. Please indicate the type of documentation
you are providing:  Tax Forms

 Bank Statements (most recent)

 Statement from Employer

 Other (explain) _____________

____________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________

22. You will be required to make a deposit of $2,200 if you are offered admission to Berea College. This deposit will be used during your
four years at Berea College to defray any emergency expenses you may have. The balance will be returned to you upon graduation.

Family's Savings
What source of funds will you use to make this deposit? ___________________________________________________________________

Sell a portion of our Land

23. If you are not able to make a full deposit of $2,200 before admission, how much will you be able to deposit? ______________________

CERTIFICATION, AUTHORIZATION AND SIGNATURES:

We declare that the information contained on this form is true, correct, and complete. Berea College has our permission to verify this
information and request additional documentation as needed.
WARNING: Providing false information may jeopardize a students visa status and may result in Berea College revoking its initial
decision to enroll the student.

Students Signature _______________________________________________________________________ Date (mm/dd/yy)_____________

Fathers/Stepfathers/Male Guardians/Sponsors Signature _______________________________________ Date (mm/dd/yy)_____________
Mothers/Stepmothers/Female Guardians/Sponsors Signature ___________________________________ Date (mm/dd/yy)_____________

06/12