iSelfSchooling Financial Aid Application

Instructions: Copy and paste this into your notepad or word application, fill it out, and email it to us.

1. Your name Mr., Miss, Ms., Mrs. ___
        Family (Surname)___________________________
        Given (First)____________________
        Middle __
2. Your permanent address:
        _____________________________
        _____________________________
3. Your date of birth: _____________________
4. Place of birth (country): _____________________
5. Country(ies) of citizenship:_______________
6. Your Social Security number: ________________
7. Your marital status: ____________
        If married, how many people are financially dependent on you? ____ 
8. Write in the amount of your last year income tax: ______
9. Write in the value of your assets at the time you complete this application. _____
10. Do you own your home? _______________
        if yes,
        c. How much do you still owe on the purchase price? U.S. $____________
        b. What was the original purchase price? U.S. $ ________
        d. What is the present market value? 
        U.S. $____________
11. Do you own an automobile(s)? _____
        If yes,
        a. Make (VW, Fiat, Ford, Toyota, etc.): __________________________________ 
        b. Year of manufacture:_______________________________

12. What iSelfSchooling product do you need?  ________

13. What is a maximum price that you can pay? ______

In return I promise that when I have no financial problem, I will pay that amount to someone else that is in need.

I declare that the information on this form is true, correct, and complete. The iSelfSchooling.com has our permission to verify the information reported.

WARNING:
Providing false information may result unexpected outcome.