Financial Aid Office

Application for Tuck Tuck School of Business at Dartmouth

100 Tuck Hall
School of Business
Hanover, NH 03755-9000 USA
Scholarships Tel: 603-646-9743
Academic Year 2011–12 Fax: 603-646-9741
tuck.financial.aid@dartmouth.edu

Personal
Information Student’s Name
Last (family) First Middle

Date of Birth

Marital Status Anticipated Number of Children

Single/Married As of September 2011

Citizenship:
U.S.
Dual and
Other

Country Country Please specify country

Yes
No
of citizenship
Are you a permanent resident of the U.S.?

Application Round
Early Action
November
January
April
Consortium

Will your spouse be an enrolled student during the 2011–12 academic year?
Yes
No

Are you deferred from a previous year?
Yes
No

Student’s and
Spouse’s Current Student’s Current Monthly Pre-Tax Salary
In U.S.$
Income
Spouse’s Current Monthly Pre-Tax Salary
In U.S.$

Student’s and
Jan. 1, 2010 to
Spouse’s Estimated
Dec. 31, 2010
2010 Taxable
Income
Gross Income Expected from Work by Student _________________
In U.S.$

Gross Income Expected from Work by Spouse _________________

In U.S.$

Business Income or (Loss) _________________

In U.S.$

Income from Interest and Dividends _________________

In U.S.$

Capital Gain or (Loss) _________________

In U.S.$

IRA Distributions (Exclude Rollovers) _________________

In U.S.$

Pensions and Annuities _________________

In U.S.$

Unemployment Benefits _________________

In U.S.$

Other Taxable Income _________________

In U.S.$

Rental Income _________________

In U.S.$

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 Financial Aid Office
Application for Tuck Tuck School of Business at Dartmouth
100 Tuck Hall
School of Business Hanover, NH 03755-9000 USA
Scholarships Tel: 603-646-9743

Academic Year 2011–12 Fax: 603-646-9741

tuck.financial.aid@dartmouth.edu

Student’s and
Spouse’s Estimated Jan. 1, 2010 to
2010 Nontaxable Dec. 31, 2010
Income
Payments to Tax-Deferred Pension and
Savings Plans (refer to pay stub) _________________
In U.S.$

Housing, Food, and Other Living Allowances

Paid to Members of the Military, Clergy, Other _________________
In U.S.$

Veterans’ Noneducation Benefits (disability, etc.) _________________

In U.S.$

Other Nontaxable Income _________________

In U.S.$

Student’s and
Spouse’s Tax
Filing Tax Form Filed Last Year or Expected to be Filed This Year
1040
1040A/EZ
Non-U.S. Tax Form(s)

2010 Estimated Income Taxes

In U.S.$

Current Value
of Student’s
and Spouse’s Cash, Savings, and Checking Accounts
Resources In U.S.$

Stocks, Stock Options, Bonds, Certificates of Deposit,

Mutual Funds, Money Market Funds, and Other Investments
In U.S.$

Trust Funds of Which You Are or Will Be the Beneficiary

In U.S.$

IRA, Keogh, 401K, etc.

In U.S.$

Home Equity
Market value minus mortgage; in U.S.$

Other Real Estate (not including primary residence)

Market value minus mortgage; in U.S.$

Will you be receiving aid from your employer

or other outside sources?
Yes, explain
No
Source

Amount; in U.S.$

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 Financial Aid Office
Application for Tuck Tuck School of Business at Dartmouth
100 Tuck Hall
School of Business
Hanover, NH 03755-9000 USA
Scholarships Tel: 603-646-9743
Academic Year 2011–12 Fax: 603-646-9741
tuck.financial.aid@dartmouth.edu

Brief Biographical
Essay Please write a short biographical essay, no longer than 500 words, telling us about
yourself. Noteworthy topics may include:
• Undergraduate degree and honors or awards
• Extracurricular activities (volunteer, leadership, sports, etc.)
• Work experience

Certification Integrity and honesty in the performance of academic activities, both in the classroom and outside,
are essential to the educational experience for which the Tuck School has always stood. Each mem-
ber of the Tuck community accepts the personal responsibility to uphold and defend high ethical
standards in all academic endeavors, and to promote an atmosphere in which honest and imagina-
tive academic work may flourish.

I certify that all the information provided on this form is accurate and complete to the best
of my knowledge.

Signature Date Signed

Street Address

City State/Province Zip/Postal Code Country

Email

To submit, please do one of the following:

Mail to:
Financial Aid Office
Tuck School of Business at Dartmouth
100 Tuck Hall
Hanover, NH 03755-9000 USA

Fax to: 603-646-9741

Email to: tuck.financial.aid@dartmouth.edu

Comments
Please attach an additional sheet if you need to explain special circumstances.

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