PARENTS’ FINANCIAL STATEMENT

PARENTS’ FINANCIAL STATEMENT

This two page statement is part of your daughter’s/son’s application for scholarship aid. It must be returned to the Edward’s Scholarship Fund, 200 Clarendon Street, 27^th Floor, Boston, MA 02116, on or before March 1, 2010.

We request this information in order to make awards carefully. Our aim is to determine the financial need of all applicants and to distribute our available funds fairly. You are therefore urged to supply any additional information which seems significant to you. All information submitted will be treated confidentially. NOTE: If applicant is self-supporting and/or married he/she should consult with the office of the Edwards Scholarship Fund regarding the process for filling out this form.

Call: 617-654-8628 Email: esfund@yahoo.com www.esfund-boston.org

_________________________________________

Name of Applicant: _______________________________________________________

(First) (Middle) (Last)

_______________________________________________________________________________________________

Father or Guardian: Mother:

1. Name_________________________________________ Name__________________________________________

2. Home Address__________________________________ Home Address___________________________________

3. Employer______________________________________ Employer_______________________________________

4. Nature of business ______________________________ Nature of business________________________________

Parent’s Annual Income (before taxes):

Actual 2009 Estimated 2010

Father $________________ Father $________________

Mother $_______________ Mother $_______________

TOTAL: $______________ TOTAL: $______________

Do you own your home? ________

If yes, what is the estimated market value? $________________

Do you have a mortgage? __________What is your monthly payment? ________________

Do you own other real estate? _________

If yes, what is the estimated market value? ________________

If you rent your home, what are your monthly payments? _______________

Parents’ Financial Statement (continued)

Please list all brothers and sisters of the applicant and indicate the extent of financial support they are receiving during the 2009-2010 academic year.

Name School/College/ or Occupation Age Support Given

______________________________ _________________________ _____ _____________

Please use this space to explain any special family circumstances that the fund should know about; for example,

divorce, separation arrangements, dependencies, illnesses, special housing problems, etc.

______________________________________________________________________________________

Please submit this financial statement with your daughter’s/son’s application.

In addition, we will need a copy of your W-2 Tax Forms by May 15^th.

Signatures of Both Parents:_________________________________________

_________________________________________

Date______________________