Document 6579498

Financial Statement for Students from
Foreign Countries
Harvard College Financial Aid Office
86 Brattle Street
Cambridge, MA 02138
(phone) 617.495.1581
(fax) 617.496.0256
2015-2016
This alternate financial aid form is intended for students without reliable internet access or for whom the cost
of the CSS PROFILE will be a financial hardship. Please refer to the Alternate Instructions for Paper
Submission for International Students for further information regarding our application requirements.
Student name (Last, First Middle): _________________________________________________________________________
Permanent address: _________________________________________________________________________________________
Address at school (if different):_____________________________________________________________________________
Phone number:_______________ Fax number: __________________Email:_______________________________________
Parent 1’s name: ____________________________________________________________________ Age: __________________
Parent 1’s occupation: _____________________________________ Employer: ____________________________________
Parent 2’s name: ____________________________________________________________________ Age: __________________
Parent 2’s occupation: _____________________________________ Employer: ____________________________________
Parents’ marital status: Married
Separated/divorced*
Other__________________
*If your parents are separated or divorced, a separate Financial Statement and their most recent tax forms
must be submitted by your noncustodial parent. Date of separation: ____________ Date of divorce: _______________
Noncustodial parent name: ___________________________________________________________________________________
Noncustodial parent address: _________________________________________________________________________________
Noncustodial parent occupation: ____________________________ Employer: ____________________________________
Has either parent remarried? Custodial parent
Noncustodial parent
This form is being submitted by the: Custodial household
Both
Noncustodial household
How many persons, including the applicant, are dependent on the family’s income? _______________
Name
Relationship to the Student
Age
Which persons, including the applicant, are or will be in school or university?
Name
2014-2015
Name of
school or
university
2014-2015
Annual cost
of
attendance
US$
US$
US$
2014-2015
Amount
provided by
family
US$
US$
US$
2015-2016
Name of
school or
university
2015-2016
Annual cost
of
attendance
US$
US$
US$
2015-2016
Amount
provided by
family
US$
US$
US$
Financial Statement for Students from Foreign Countries 2014-2015
Please list family’s total annual income in U.S. dollars:
2
Exchange rate:__________=1US$
Actual 2013
Estimated
Estimated 2015
Income
2014 Income
Income
US$
US$
US$
Parent 1’s gross earnings
US$
US$
US$
Parent 2’s gross earnings
US$
US$
US$
Other income* ________________________________
US$
US$
US$
Other income* ________________________________
US$
US$
US$
Other income* ________________________________
US$
US$
US$
TOTAL
US$
US$
US$
Annual income taxes paid
*Please include interest and dividend income, business income, real estate income, pension and retirement
income, as well as any other forms of income in ‘other income’.
Documentation must be provided to verify the financial information requested above. If a national
tax return is filed you must submit it in full. Please check the type of documentation you are or will
be sending: Tax forms
Statement from employer
Other_____________________
Is either parent self-employed or does any family member hold an interest in any business/farm?
If so, a Business/Farm Supplement, available from our website, may be required.
Name of business/farm:______________________________________________________________________________________
Parents’ position(s): ________________________________________________ Percent owned:_______________________
Please list your parents’ total assets below, in U.S. dollars:
Family home
Year purchased:__________________________________
Purchase price: US$________________________________
Land and buildings (other than home)
Year purchased:__________________________________
Purchase price: US$________________________________
Cash/savings
Investments (stocks, bonds etc)
Business or farm
Debts owed to the family
Please explain_______________________________________
Trusts (please provide details, including accessibility, on page 3)
Funds set aside for retirement
Assets belonging to siblings under age 18
Other ________________________________________________________
Present Value
Amount Owed
US$
US$
US$
US$
US$
US$
US$
US$
US$
US$
US$
US$
US$
US$
US$
US$
US$
US$
US$
US$
How much money does your family owe to other people? _______________________________________________
Reason for debt ______________________________________________________________________________________________
Does your family hold assets in another country? If so, please provide details in the space on page 3.
Financial Statement for Students from Foreign Countries 2014-2015
3
List student’s assets:
Total Amount
Cash/savings
Investments
Trusts
Real estate
Source (e.g. parents’ savings, gifts,
earnings)
US$
US$
US$
US$
List average amounts of money spent each year by your family for:
Rent or mortgage
Utilities
Food
Clothing
Education
Taxes
Loan/debt payments
US$
US$
US$
US$
US$
US$
US$
Savings or retirement plans
Automobile maintenance
Insurance
Entertainment
Vacations
Domestic help
For how many employees?
US$
US$
US$
US$
US$
US$
Please list your outside awards/support from government agencies below:
Name of scholarship/donor
Amount expected in 2015-2016
US$
US$
US$
Please use the space below to explain your answers to the above questions or to give additional
information which you would like the Committee on Financial Aid to consider while reviewing your
application. You may also attach an additional sheet.
Signature of Parent 1: _________________________________________________________________________________________
Signature of Parent 2: _________________________________________________________________________________________
Signature of Student: __________________________________________________________________________________________