the amounts below · 2015-2016 Academic Year &TUJNBUFT Tuition Differs by unit/department Student...

for Completing the Academic and Financial Review Form When completing the form, please the amounts below as a guide. If actual figures or

offical estimations vary for your program, you can insert custom numbers. However, all numbers must reflect a full course of study and must be consistent for all students in the program. Numbers cannot be adjusted for a student's personal circumstances. Every summer, OIA updates this page of the form. Please obtain the form from our website whenever you use it rather than downloading it to your machine, as you would not receive updates. As you enter amounts in the form, please tab through the form, as this will allow the document to automatically calculate the figures. Do not use commas or decimalpoints when completing the form. Additional instructions are contained on page 2.

2015-2016 Academic Year

Tuition Differs by unit/departmentStudent Life Fee** $363 (grad) or $389 (College)/quarter for every quarter enrolled Living Expenses (LE)* $6,000/quarter for each quarter, including summer Health Insurance** $1144/quarter for every quarter enrolled Books $475/for every quarter enrolledDependent LE** $1,000/quarter for each quarter and each dependent (ex: 2 dependents for one full year = $8000) ** Indicates fixed cost that cannot be customized* The phrase “For each quarter” above means every quarter the student or dependent is present, not only those quarters when the student is enrolled. Living expenses must be included for each quarter the student is present. For example, if a student extends through the autumn quarter, then living expenses for the summer must be included, even if the student will not be enrolled during the summer. Full-time vs Part-time Enrollment: Even if the student will be enrolled in approved part timecourses, full time enrollment costs must be listed and documented. University funding/support: full expenses must by listed by line item per quarter on the form. List any funding/support the student receives from the University in the 'University of Chicago Support' section.

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mckeglerTypewritten Text




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MikeTypewritten TextAcademic and Financial Review Form: Administrator Section

MikeTypewritten Text












MikeTypewritten TextExtensions: I confirm the student is making progress and extension is based on academic need.


MikeTypewritten TextEstimated Cost of Attendance (for duration of extension)

MikeTypewritten TextExpected Completion Quarter









MikeTypewritten TextStudent ID:


MikeTypewritten TextProgram:





MikeTypewritten TextStudent Name:



MikeTypewritten TextRequest Type:

MikeTypewritten TextYear


MikeTypewritten TextFor Return from LOA, COL, and COS: Starting Quarter

MikeTypewritten TextYear














MikeTypewritten TextTuition

MikeTypewritten TextLiving Expenses



MikeTypewritten TextStudent Life Fee


MikeTypewritten TextHealth Insurance

MikeTypewritten TextBooks

MikeTypewritten TextSpouse's LE

MikeTypewritten Text1st Child's LE

MikeTypewritten Text2nd Child's LE

MikeTypewritten TextQuarterly Total


MikeTypewritten TextFall 20

MikeTypewritten TextWinter 20

MikeTypewritten TextSpring 20



MikeTypewritten TextSummer 20




MikeTypewritten TextTuition & Fee Total:

MikeTypewritten TextLiving Expense Total:

MikeTypewritten TextDependent Expense Total:

MikeTypewritten TextUniversity of Chicago Support


MikeTypewritten TextAmount




MikeTypewritten TextSource













MikeTypewritten TextTotal Expenses:

MikeTypewritten TextTotal Support





MikeTypewritten TextDifference:







MikeTypewritten TextAdministrator Name


MikeTypewritten TextSignature

MikeTypewritten TextDate








MikeTypewritten TextAFR: Student Section





MikeTypewritten TextFinancial Resources (List total amount of funding in USD for each source)


MikeTypewritten TextSelf

MikeTypewritten TextFamily or Private Sponsor

MikeTypewritten TextEmployer

MikeTypewritten TextInsitutional or Government Support

MikeTypewritten TextOther

MikeTypewritten TextExplain

MikeTypewritten TextTotal Resources (not including support from university)

MikeTypewritten TextName

MikeTypewritten TextStudent ID

MikeTypewritten TextEmail

MikeTypewritten TextDelivery Preference

MikeTypewritten TextI will pick up my document from the Office of International Affairs.

MikeTypewritten TextI will pay for express shipping of my document following these instructions:

MikeTypewritten TextI would like my document sent to the address below using regular mail/airmail (free of charge):





















MikeTypewritten Texthttp://tinyurl.com/oiaeship










mckeglerTypewritten TextThis form is in writeable PDF format and may be filled in on-screen by the student, then printed and signed by theadministrator and the student. Amounts entered will calculate automatically.To receive a program extension of more than one year, the student must show financial resources for at least onecalendar year, which includes living expenses for the summer. To receive a program extension of less than oneacademic year, the student must show resources for the remaining length of the program.Support may come from several sources: Financial support provided by the University of Chicago should be listed by the administrator on page 2 of the AFR. If it is listed on page 2, no further documentation is needed. The administrator’s signature certifies that the amount of support stated in this form is granted to the student.All other sources of support must be documented separately, and the documentation must accompany this form.Documents may be no more than 6 months old at the time this form is submitted. All such documents must be onletterhead and clearly show the name of the individual or organization providing the support. Personal funds: A bank statement specifying the amount on deposit in your name.A statement from your employer, stating your salary and that it will continue while youare a student. Funds from family or other private sponsor or from employer:A statement from the sponsor indicating the amount and duration of support AND documents showing that these funds are available. OIA has a sponsor letter template here: Funds from an institution or government:Award letter stating the amount of support and length of study to be supported.




mckeglerTypewritten TextStudent Instructions



















http://tinyurl.com/oiaeshipmckeglerTypewritten Texthttp://tinyurl.com/sponsorltr

http://tinyurl.com/sponsorltr

Dropdown1: [Autumn]Dropdown2: [Program Extension]Dropdown4: [n/a]Dropdown3: [2013]Dropdown5: [n/a]Tuition Total: 0LE Total: 0Dependent LE Total: 0Total Expenses: 0Total Support: 0Support Amount 1: Support Amount 2: Support Amount 3: Source 2: Source 3: Admin Name: Signature: Signature Date: Program: Fall Year: Spring Year: Summer Year: Check Box4: Offstreet address: citystateprovince: countrypostalcode: Source 1: Employer: Government: Other: Self: Student Total: 0Family: Explanation: Student Name: Student Email: Student ID: Quarterly Spring: 0Tuition Winter: SLF Winter: LE Winter: HI Winter: Books Winter: Spouse Winter: 1st Child Winter: 2nd Child Winter: Quarterly Winter: 0LE Summer: Quarterly Summer: 02nd Child: 1st Child Summer: Spouse Summer: Books Summer: HI Summer: LE Spring: SLF Spring: Tuition Spring: HI Spring: Books Spring: Spouse Spring: 1st Child Spring: 2nd Child Spring: Winter Year: SLF Summer: Tuition Summer: Tuition Fall: SLF Fall: LE Fall: HI Fall: Books Fall: Spouse Fall: 1st Child Fall: 2nd Child Fall: Quarterly Fall: 0Difference: 0Student ID (student entry): Student Name (student entry): Delivery: Choice1

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