HARVARD UNIVERSITY

Committee on General Scholarships

Application and Guidelines for Scholarships for Argentinean Students
Academic Year 2015-2016
1. The Amalia Lacroze de Fortabat Fellowships support graduate students at Harvard University
who are citizens of Argentina. The scholarships are made possible by the generosity of Amalia
Lacroze de Fortabat. Candidates are evaluated on the basis of merit and financial need. Priority is
given to degree candidates in fields that will enable them to contribute to Argentinas social,
economic and scientific progress; to the formulation of public policies that strengthen Argentine
democracy, or to Argentinas academic and professional development. Fellowship recipients are
expected to return to Argentina after the completion of their degrees.
2. The Francis and Peggy Cahn Fund for Argentina will support Argentinean students studying at
the Harvard Graduate School of Arts and Sciences in the Engineering, Applied, Physical and Life
Sciences; the Harvard T.H. Chan School of Public Health, the Harvard Kennedy School, or the
Harvard Graduate School of Education. Candidates are evaluated on the basis of merit and financial
need. It is the donors wish that recipients have plans to return to Argentina and utilize their
education to enable them to contribute to Argentinas social, economic, and scientific progress, and
priority consideration will be given to those candidates.
The fellowships are awarded for one academic year. Recipients may apply for renewal for a second year.
Candidates must apply to and be accepted by their school of choice at the University independent of this
Fellowship application. Admission to the University does not guarantee a Fellowship award.
Submitting the Fellowship Application
The application requires the following materials:

A completed and signed Fellowship Application Form

Resume or Curriculum Vitae
Statement of Purpose. In a short essay, not to exceed 500 words, please discuss your plan of study at Harvard
University and your career goals.
Requirement of Continuing Students Only: Letter from advisor which confirms that you are making satisfactory
progress.

The application form may be downloaded from the website at www.scholarships.harvard.edu or requested by
emailing: cgs@fas.harvard.edu.
DEADLINE:

Applications must be received by 5:00p.m. on Wednesday, April 1, 2015.

Incomplete applications will not be reviewed.

Applications may be scanned and sent via email to: cgs@fas.harvard.edu or they can be mailed to:
Chairman
Committee on General Scholarships
Harvard University
14 Story Street, 3rd Floor
Cambridge, MA 02138 USA

Applications submitted via email should be scanned and sent as one attachment and include the application
form, resume or curriculum vitae, and the statement of purpose. The application should also include a
scanned signature for the Applicants Certification and Permission to Release Information section of the application
form.
For continuing students only: the letter confirming satisfactory progress should be sent separately via email by the
advisor. It must be on university letterhead and bear his/her signature.
Contact Information
Questions about the application, guidelines, or eligibility requirements of the Amalia Lacroze de Fortabat
Fellowship or the Francis and Peggy Cahn Fund for Argentina should be directed to the Committee on
General Scholarships at 617-496-9367 or cgs@fas.harvard.edu.
Questions about the academic programs at any Harvard graduate or professional school, or the admissions
procedures or guidelines, should be directed to the admissions offices of the school of your interest. Links to
each Harvard school may be found on the Harvard University homepage at: www.harvard.edu.
Thank you for your interest in the Amalia Lacroze de Fortabat Fellowship and the Francis and Peggy Cahn
Fund for Argentina.

HARVARD UNIVERSITY
Committee on General Scholarships
Application for Scholarships for Argentinean Students
Academic Year 2015-2016
CGS Must Receive Applications by:
April 1, 2015 at 5:00p.m.

Please type or print legibly. All information will be treated confidentially.

I. General Information
Last Name: ___________________________
(Please capitalize paternal name)

I am applying for the following fellowship(s):

First Name: ___________________________

de Fortabat Fellowship

Cahn Fund Fellowship

Information required from continuing Harvard students only:

Harvard I.D. Number: ___________________
Local Address: ________________________________________________________________________
Telephone Number: ____________________

Harvard Email: __________________________

Information required from all applicants:

Permanent Address in Argentina: __________________________________________________________
__________________________________________________________
Telephone Number in Argentina: ______________________
Citizenship: _____________________

Email Address: _____________________

Visa type: ________________________

Do you hold dual/joint citizenship? Yes___ No___ (please check one)

Date of birth: ______________________

If so, where: __________________

Marital Status: Married___ Not Married___ (please check one)

Do you have any relatives who currently reside in the United States? Yes___ No___ (please check one):
If yes, what are their relationships to you? ___________________________________________________
Please provide the following information about your dependents (if any):
Name

Age

Relationship

Will he/she live with you in Cambridge?

____________________________________________________________________________________
____________________________________________________________________________________
3

II. Educational Information and Background

Harvard Graduate or Professional School you attend ___ / plan to attend ___ (please check one):
School: ______________________________________________________________________________
Degree Program: ______________________________________________________________________
Expected Graduation Date: ______________________________________________________________

I have submitted my application for admission to this degree program in accordance with the guidelines
established by the school. My application identification number is: ________________.
(Applicants to HSPH should use their SOPHAS ID #)
Please list all universities you have attended to date:
Name

Location

Degree

Graduation Date

_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
III. Financial Information
Have you applied for financial aid from the Harvard School you attend/plan to attend?
Yes___ No ___ (please check one)
Have you been awarded a teaching fellowship or proctorship for the upcoming year?
Yes___ No ___ (please check one)
Please list all educational loans with outstanding balances (including loans that have been granted for
academic year 2015-2016):
Source of Loan

Original Amount (U.S. Dollars)

Balance Due

Date Payable in Full

_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Please list all scholarships you have applied for or have been granted for the 2015-2016 academic year:
Scholarship Source

Amount (U.S. Dollars)

Is this a definite award (yes or no)?

_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
4

Please provide the following information on your current employment and, if applicable, that of your spouse:
Employer

Position

Monthly Salary (US$)

Dates of Employment

You:

________________________________________________________________________

Your Spouse:

________________________________________________________________________

Please list the combined financial resources and debt associated for you and, if applicable, your spouse for the
2015-2016 academic year:

Resources (in US Dollars):

Wages:

Other income (list):

$
$
$
Cash savings:

Cash gifts:

Loans for academic:

year 2015-2016 (list)
$
$
$
Scholarships (total
from list on the
bottom of page 4):

Anticipated Expenses (in US Dollars):

Tuition:

Health insurance:

Other required fees:

Books/supplies:

Rent/room charges:

Food/board charges:

Utilities:

Transportation:

Clothing:

Medical Expenses:

$
Other (list):

Other (list):

$
$
$
$

$
$
$

Total Resources:

Total Expenses:

Please list the value and debt associated with any assets currently owned by you and if applicable your
spouse:
Total Value
Associated Debt
(U.S. Dollars)
(U.S. Dollars)
Cash, savings, bank accounts:
Personal residence:
Location:
Other real estate owned:
Location:.
Location:.
Business or farm:
Stocks, bonds, securities:
Trusts and estates:
Other (list):
.
.
TOTALS:

$_____________

$____________

$_____________

$____________

$_____________
$_____________
$_____________
$_____________
$_____________

$____________
$____________
$____________
$____________
$____________

$_____________
$_____________

$____________
$____________

$_____________

$____________

Please provide the following parental information:

Father:

Mother:

Living ___ Deceased ___ (please check one)

Living ___ Deceased ___ (please check one)

Age:____

Age:____

Occupation:_________________________

Occupation:_________________________

2014 Salary (U.S. Dollars):_____________

2014 Salary (U.S. Dollars):_____________

Please list the value and debt associated with any assets currently owned by your parents:
Total Value
(U.S. Dollars)
Cash, savings, bank accounts:
Personal residence:
Location:
Other real estate owned:
Location:.
Location:.
Business or farm:
Stocks, bonds, securities:
Trusts and estates:
Other (list):
.
.
.
.
TOTALS:

Associated Debt
(U.S. Dollars)

$_____________

$____________

$_____________

$____________

$_____________
$_____________
$_____________
$_____________
$_____________

$____________
$____________
$____________
$____________
$____________

$_____________
$_____________
$_____________
$_____________

$____________
$____________
$____________
$____________

$_____________

$____________

Attachments of Supporting Documentation

Using a separate sheet(s) of paper (single-sided), include the following documentation to support your application.
Please see the Fellowship Application Guidelines for additional information about submitting attachments.
a. ____ Resume or Curriculum Vitae.
b. ____ Statement of Purpose. In a short essay, not to exceed 500 words, please discuss your plan of study at Harvard University and
your career goals.
c. ____ Requirement of continuing students only: Letter from advisor which confirms that you are making satisfactory progress.

Applicants Certification and Permission to Release Information

I __________________________________ certify that the information provided in this fellowship

(print your name)

application is complete and accurate to the best of my knowledge. In addition, by signing below, I hereby grant
permission to the Admissions and Financial Aid Office(s) of ___________________________________________
(print the name of your Harvard School)

to release copies of my Admissions and Financial Aid Application packages to the Committee on General
Scholarships for use by its fellowship selection committee in evaluating my candidacy for an Amalia Lacroze
de Fortabat and/or Francis and Peggy Cahn Fund Fellowship.

Signature: __________________________________________

Date: __________________________________