UWC Financial Circumstances
Declaration Form
Instructions
On this form, you are invited to give an overview of your family circumstances and
financial situation. UWC relies on students’ families contributing to the cost of their
child’s UWC education to the largest extent possible. The information in this form will
help UWC determine the appropriate financial contribution expected from you towards
your child’s UWC education. The more information you provide, the more precisely
UWC can determine a fair contribution and the simpler the process will be.
Please note:
● When providing financial information, please use the same currency throughout
the form. Ideally, the local currency for your country of residence.
● Please complete the right hand columns of this form and return a signed version
to your National Committee once done.
● Divorced / separated parents can submit separate Financial Circumstances
Declaration Forms if they wish to do so. Please indicate if a separate form will be
submitted in Section 1.
● If one of the required fields doesn't apply to you, please insert "0" or “n/a”.
● When submitting information to the National Committee processing your child’s
application, please be sure to provide supporting documents.
Section 1: Applicant information
Applicant Full Name:
Yamilka Altagracia Acosta Valdez
Who does the applicant currently live Parent(s): Yes
with?
Stepparent(s): N/A
Guardian(s): N/A
Sibling(s): N/A
Others:
Please specify
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UWC Financial Circumstances
Declaration Form
Parent / guardian 1 full name
Jose Alberto Acosta Valdez
Parent / guardian 2 full name
Please mark if deceased, not applicable Lourdes Maria Valdez
(in the case of single parents) or whether
parent / guardian 2 will submit a separate
form.
Application via UWC National Committee: DOMINICAN REPUBLIC
Currency you’ll be using to fill out this RD$ (PESOS DOMINICANOS)
form: UD$1 = RD$ 56,89
Please be consistent throughout
Section 2: Household information
How many financially independent adults 2
currently live in your household?
This is the number of people over the age
of 18 who contribute to the household
income
How many financial dependents currently Aged 18 or under: 1
live in your household?
This includes children and adults that are
financially supported by the household’s Aged over 18: 2
income such as elderly relatives or
children at university.
Please include the UWC applicant in this
figure.
What type of accommodation does the Apartment:
applicant currently live in?
House (single family): Yes
Please mark relevant box
House (extended family):
E.g. With grandparents
and other relatives
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UWC Financial Circumstances
Declaration Form
Other:
Please specify
How much does the family anticipate House (nuclear family) With parents and
being able to save per year if the siblings: 50,000.00 DOP
applicant goes to UWC?
Please list the amount the family expects
to be able to save per year while the
applicant is at UWC.
Section 3: Household Income
Please complete the table below for both parents / guardians, and specify how much
each parent / guardian earned in the past financial year (using the tax year if applicable)
after tax and social security contributions.
Please be sure to use the local currency for your country throughout when completing
the form. (See Section 1)
When submitting information to the National Committee processing your child’s
application, please be sure to provide the necessary supporting documents.
Annual income after tax Parent / Guardian 1 Parent / Guardian 2
Employment income / 144,000,000 DOP
salary:
Rental income from N/A
property/(ies):
Stocks and shares:
What is your total net
income for next year likely
to be?
Please include overall
income from all three
sources listed above
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UWC Financial Circumstances
Declaration Form
How much other net
income did your household
earn during the past year?
Please include after tax
income received by any
household member not
already included. This
includes but is not limited
to net income from
dividends, rent charged on
main family home (e.g.
lodgers), government
subsidies, gifts from other
family members (e.g.
grandparents).
Please use the space in
the neighbouring box to
provide any additional
comments you would like
to make
Section 4: Household Expenses
If the applicant’s parents / guardians are separated or divorced and are not submitting
separate forms, please complete both columns. If both parents / guardians live in the
same household, please only complete the column marked “Total or Parent / Guardian
1 (if separated or divorced)” and leave the other column blank.
Do both parents /
guardians live in the same
household?
How much would it cost to
educate the applicant per
year if they did not attend a
UWC?
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UWC Financial Circumstances
Declaration Form
What is the total annual
cost to the family to
educate all other
dependents?
How many dependents in
the applicant’s household
will attend tuition-charging
institutions in the two
school years the applicant
will be at UWC?
This includes but is not
limited to private schools
and universities.
Total or Parent / Parent / Guardian 2
Guardian 1 (if separated (if separated or divorced)
or divorced)
What is the total annual N/A
amount spent on rent /
mortgage payments on the
main family home and any
other properties owned?
What is the annual cost of
utility bills, compulsory
health insurance, and
commuting costs?
What is the annual total of
all other household costs?
How much outstanding
debt do you have?
This includes, but is not
limited to: credit cards,
personal loans, payday
loans, etc..
Section 5: Family Assets
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UWC Financial Circumstances
Declaration Form
If the applicant’s parents / guardians are separated or divorced, please complete both
columns. If both parents / guardians live in the same household, please only complete
the column marked “Total or Parent / Guardian 1 (if separated or divorced)” and leave
the other column blank.
Does your child own any
assets?
E.g. a savings account
If yes, how much do these
assets total?
Total or Parent / Parent / Guardian 2
Guardian 1 (if separated (if separated or divorced)
or divorced)
Do you own your main Yes
family home?
When was the home 12/09/2008
purchased?
What was the purchase
price of the home?
What is the current 1,000,000 DOP (million
approximate market value Dominican Peso)
of your main family home?
What is the current value N/A
of the outstanding
mortgage on your main
family home, if applicable?
Does the family own any N/A
other property(ies)?
After expenses, how much N/A
net annual income does
your family receive from
other property(ies)?
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UWC Financial Circumstances
Declaration Form
Does your family have any N/A
money, property, or assets
in another country?
If yes, please specify
which country.
How much net annual
income is earned from
these assets?
What is the total value of
your cash, savings and
checking accounts as of
today?
What is the total net value
of all your other assets,
excluding real estate and
cash, savings and
checking accounts?
This includes investment
portfolios, bonds, stocks,
mutual funds, etc...
Do not include the value of
your pension fund.
What is the expected 2.5%
percentage return on your
assets?
Use 2.5% if unsure
If there are other factors you have not included in this form that would impact the
financial information provided above, please note them below.
E.g. expected political, social or economic developments such as currency
fluctuations, changes in family circumstances, medical issues, etc..
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UWC Financial Circumstances
Declaration Form
PLEASE NOTE: Providing false information may delay your child’s nomination process,
and may jeopardise their admission.
Signature of parent or guardian 1: _________________________________
PRINT NAME: _________________________________
DATE: _________________________________
Statement of Truth
I declare that the information reported on this form is, to the best of my knowledge and
belief, true, correct, and complete.
Signature of parent or guardian 2: _________________________________
PRINT NAME: _________________________________
DATE: _________________________________
Statement of Truth
I declare that the information reported on this form is, to the best of my knowledge and
belief, true, correct, and complete.