Harvard College Griffin Financial Aid Office

Financial Statement for Students from Foreign Countries

Last Name: _________________ First Name: ____________________

Date of Birth (Month/Day/Year):______________________________

(For Current Students) HUID: __________

Please fill out the Financial Statement form and provide supporting documentation. If a national tax
return is filed, it must be submitted in full.

What are you sending to verify income?

Parents’ 2020 National Tax Document, Wage Statement, or

Payslips Letter from Employer
2020 Business/Farm/Corporate/Partnership Tax Document(s)
Letter of Special Circumstance
Other (please specify):__________________________________
Harvard College Griffin Financial Aid Office 2022-2023 Financial Statement for Students
from Foreign Countries

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 our website for further information regarding
our application requirements.
HUID (Current Students Only): ___________________________________________________________________

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 Both

This form is being submitted by the: Custodial household 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 2021-2022 2021-2022 2021-2022 2022-2023 2022-2023 2022-2023

Name of Annual cost Amount Name of Annual cost Amount
school or of provided by school or of provided by
university attendance family university attendance family
US$ US$ US$ US$
US$ US$ US$ US$
US$ US$ US$ US$
Financial Statement for Students from Foreign Countries 2022-2023 2

Please list family’s total annual income in U.S. dollars: Exchange rate:__________=1US$

Actual 2020 Actual Estimated

Income 2021 Income 2022 Income
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 US$ US$ US$
*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 attached 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 have
attached: 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:

Present Value Amount Owed

Family home US$ US$
Year purchased:__________________________________
Purchase price: US$________________________________
Land and buildings (other than home) US$ US$
Year purchased:__________________________________
Purchase price: US$________________________________
Cash/savings US$ US$
Investments (stocks, bonds etc) US$ US$
Business or farm US$ US$
Debts owed to the family US$ US$
Please explain_______________________________________
Trusts (please provide details, including accessibility, on page 3) US$ US$
Funds set aside for retirement US$ US$
Assets belonging to siblings under age 18 US$ US$
Other ________________________________________________________ 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 2022-2023 3

List student’s assets:

Total Amount Source (e.g. parents’ savings, gifts,

earnings)
Cash/savings US$
Investments US$
Trusts US$
Real estate US$

List average amounts of money spent each year by your family for:

Rent or mortgage US$ Savings or retirement plans US$

Utilities US$ Automobile maintenance US$
Food US$ Insurance US$
Clothing US$ Entertainment US$
Education US$ Vacations US$
Taxes US$ Domestic help US$
Loan/debt payments US$ For how many employees?

Please list the amount your parents think they can pay for educational costs this year: _________________

Please list your outside awards/support from government agencies below:

Name of scholarship/donor Amount expected in 2022-2023

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: __________________________________________________________________________________________