Harvard College Project for Asian and International Relations Financial Statement

Last Name: _______________ First Name: ________________

Date of Birth: _____ / ________ / _______

DAY MONTH YEAR

Email Associated with Application: __________________________

Please out the Financial Statement form and provide supporting documentation. If a national tax

return is filed, it must be submitted in full when possible. The more documentation provided, the

stronger your application will be in determining financial need. However, if you encounter

significant difficulty in providing documentation, make a note as to why (national holiday,

parents unable to provide information, etc) on the final page and it will not be counted against

your application. If you have any questions, please visit the Scholarships section of the Help

Center.

What are you sending to verify income?

Parents’ 2022 National Tax Document, Wage Statement, or Payslips*

Individuals’ 2022 National Tax Document, Wage Statement, or Payslips*

Individuals’ Checkings/Savings Account Statement(s)**

Parents’ Checkings/Savings Account Statement(s)**

2022 Business/Farm/Corporate/Partnership Tax Document(s)***

*Either the parents’ tax document or individuals’ tax document is required. If you rely partially or fully on your
parents for financial support, please include your parents’ tax documents if possible. If you are unable to provide
documentation, please make a note on the last page and it will not count against your application.
**If applicable, please provide a bank account statement from your checkings or savings account for at least the past
month, preferably the last three months. If you are financially dependent on your parents, please include their bank
account statements if possible.
***If applicable.
Harvard College Project for Asian and International Relations Financial Statement

Applicant name (Full Name):

Permanent Address:

Address at school (if different):

Phone 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 (CIRCLE ONE): Married/Separated/Divorced* OR Other

Please submit the following fields according to your custodial household.

How many persons, including the applicant, are dependent on the family’s income?
Name Relationship to the Applicant Age
You N/A

Which persons, including the applicant, are or will be in school or university?

Name 2023-2024 2023-2024 2023-2024 2023-2024 2023-2024 2023-2024
Name of Annual Amount Name of Annual cost Amount
school or cost of provided school or of provided
university attendance by family university attendance by family
US$ US$ US$ US$
US$ US$ US$ US$
US$ US$ US$ US$
Harvard College Project for Asian and International Relations Financial Statement

Please list the exchange rate from local currency to U.S. dollars: Exchange rate: =1 US$

Actual 2021 Actual 2022 Estimated 2023

Income Income Income
Your gross earnings 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$

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 you filed
a national tax return, you must submit it in full.

Is either parent self-employed or does any family member hold an interest in any business/farm?
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$
Harvard College Project for Asian and International Relations Financial Statement

Please explain: __________________________

Trusts (please provide details, including accessibility, on US$ US$
page 3)
Funds set aside for retirement US$ US$
Assets belonging to siblings under age 18 US$ US$
Other ______________________________________ US$ US$

List applicants’ assets:

Total Amount Source (e.g. parents’ savings,
gifts, earnings)
Cash/savings US$
Investments US$
Trusts US$
Real estate US$

List applicants’ and parents’ bank account statements*:

Account Account type Account type
Balance (checkings, (checkings,
savings, other) savings, other)
Applicant US$ US$
Spouse (if applicable) US$ US$
Parent 1 (if applicable) US$ US$
Parent 2 (if applicable) US$ US$
*Please also attach documentation for bank account statements.

List average amounts of money spent each year by your family for:
Rent or mortgage US$ Savings or retirement US$
plans
Utilities US$ Transportation US$
Food US$ Insurance US$
Clothing US$ Entertainment US$
Education US$ Vacations US$
Taxes US$ Loan/debt payments US$

Please list the amount you and your family can pay towards conference fees: ________________

Please list your outside awards/support from other sources below:

Name of scholarship/donor Amount expected
US$
US$
US$
Harvard College Project for Asian and International Relations Financial Statement

Please use the space below to explain your answers to the above questions or to give additional
information which you would like HPAIR to consider while reviewing your application. If you
were unable to collect documentation, please explain why here and it will not negatively affect
your application. You may also attach an additional sheet.

By signing this form, you agree to the following:

I certify that, to the best of my knowledge, the information above is correct and complete. I
understand that falsification of any of the above information could jeopardize acceptance and
scholarship eligibility.

Signature of Applicant: __________________________________________________________

Date: ________________________________________________________________________