1. PhD Child Care Stipend Application 2015-16 The University of Chicago will offer need-based, annual child care stipends in the amount of $2,000 (disbursed quarterly in $500 increments) to eligible PhD student applicants. While not covering the bulk of child care expenses, these stipends are intended to help alleviate some of the financial hardship our student parents face while allowing them flexibility to tailor child care to their needs. Priority will be given to eligible applicants with the greatest need. ELIGIBILITY One application per family will be considered, and students of any citizenship may apply. Anyone who meets the eligibility criteria below may apply, but applicants with the greatest need and especially those with a total pre-tax household income of $50,000 or less will be given preference. Students must apply annually and receiving the stipend previously does not guarantee future support. Child Care Stipend applicants must: Have dependent child(ren) born on or after July 1, 2005; Be registered in fall quarter, 2015, as a full-time UChicago PhD student to receive the stipend; Be in good academic standing; and Hold valid visa and be eligible to receive income at the time of award (if applicable). Winter quarter applicants must also have one of the following reasons to justify winter application: Became a new parent since fall deadline (October 16, 2015) Returned from leave Able to document a decline in financial circumstances APPLICATION PROCESS Applicants must submit the materials below to UChicagoGRAD and will be notified of decisions and paid by early spring quarter. Students who cannot meet the document requirement should consult UChicagoGRAD (see contact information below). Please submit:  PhD Child Care Stipend Application  Copies of most recent US or foreign tax return for student and spouse/partner (if applicable)  Copies of two most recent pay stubs for all working adults in the household  Documentation that you have child(ren), including one of the following: Tax returns (above) if you have claimed the child(ren) as dependents A copy of the child(ren)’s birth certificate(s) or adoption paper(s) A copy of the child(ren)’s US passport(s) For security reasons, we cannot accept applications via email. Submit completed applications and materials via hard copy or fax (773.702.1194) to: Lizanne Phalen, Dir., FRC - Family Resource Center (FRC) - 950 E. 61 st St. - Chicago, IL 60637 Applications must be received by 5:00 p.m. on the deadline date (October 16, 2017 in fall and March 4, 2016 in winter). Incomplete applications and applications received after the 5:00 p.m. deadline will not be considered. Applicants who falsify any information or supporting documentation will be required to pay back the stipend in full, will be deemed ineligible for future stipend awards, and will be referred for area disciplinary action. INFORMATION FOR AWARDEES Stipend payments are taxable to the recipient, and depending on the student's immigration status, the University may have a legal obligation to withhold income taxes from the payment and report it. Recipients should consult a tax advisor for an understanding of their reporting obligations to the IRS. In order to receive the stipend, domestic students may be asked to provide copies of the Form W-9 and foreign students may be asked to provide copies of Form W-8, Form UPP-192, I-94 cards, and Form DS-2019. Child care stipends may also affect student loan borrowing eligibility, and awardees should consult Student Loan Administration with questions related to student loans. grad.uchicago.edu

2. Winter quarter applicants must submit documentation showing eligibility if returning from leave or reporting a decline in financial circumstances since October 2015. PhD Child Care Stipend 2015-16 Application Form Name: UCID#: Address: Apt.#:E-mail: City: State:Zip:Phone: Country of Citizenship & Visa Status (for tax purposes): Division/School:Department: Year you started your PhD program:Admitted to PhD candidacy? Y___ N___ FAMILY FINANCIAL INFORMATION Report all projected pre-tax income for 10/01/2015-9/30/2016). If the information below reflects a significant change in income from your tax forms or if you are not submitting tax forms, explain on reverse. APPLICANT DEPENDENT CHILD(REN) BORN ON OR AFTER 7/1/2005 Name Date of Birth 1. 2. 3. Income SourceStudentSpouse/Partner (if applicable) Graduate stipend and/or teaching remuneration$$ Other internal and external fellowship stipend (do not include funds that cover tuition or health insurance) $$ Employment $$ Child support$$ Alimony$$ Other (please explain on reverse)$$ Estimated assets (cash, savings, checking, investments) as of today $$ I certify that this information is true, complete, and given in good faith. SignatureDate grad.uchicago.edu