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Stipend Request Form

Check requests cannot be processed until all information on the form is completed. All stipend requests must include a detailed budget. As of Jan. 1, 2011, all requests to defray the costs of graduate school applications will be limited to $500. Stipend requests cannot be used for a salary.  The funds must go to cover specific expenses (transportation costs, rent, food, tuition for a summer program, items purchased, etc.).

Stipend requests must be submitted by February 1 for individuals graduating at the end of that semester. We cannot accept stipend requests from our graduating seniors after that date.

Please note that check requests require five weeks to process.

Date:

Name:

Student ID:

Email:

Phone:

Academic class:

Cumulative GPA:

Scholar designation: (select one)

Artist
Boatwright
 Oldham
 Science

Anticipated graduation date:

Are you a U.S. citizen: Yes No

Please send check to the following mailing address:

Address:
City:
State: ZIP code:

Description of project:

Budget for use of stipend. Please be as specific as possible, including documentation of where
the amounts of items have been found (websites used, program costs, etc):

Date of project:

Location of project:

Note: If the amount of any grant, scholarship or assistantship (i.e. any gift aid) included in an award exceeds the total of tuition, fees, books, supplies and equipment required for course work, then the excess amount must be included in your gross income as reported to the internal revenue service and may be subject to taxation. If your award requires any service in return (i.e. teaching or research), all aid might require inclusion in your gross income. International students: Based on Internal revenue Code (IRC) §§1441-1464 and related sections of the IRC (effective January 1, 2001), the portion of scholarship that is considered non-qualified (above and beyond the cost of tuition, books and health insurance) must be reported to the IRS, unless the grant is from sources outside the US. The non-qualified portion of a scholarship is also taxable at a rate of 14% for individuals in F, M, J or Q visa status. (A tax treaty may apply.) This means that your stipend may be taxable and it is your responsibility to cover the taxes. Please make an appointment to visit Devon Slough in the Office of International Taxation

*Please initial here, indicating that you have read the information above: