HUCTW Academic Enrichment Fund Application

Please complete one application per eligible child
Personal Information
Your Name*
First Last
ID Number*
Preferred Daytime Phone*
Preferred Email*
Harvard School and Department*
Address*
Street Address Address Line 2 City State ZIP Code
Household and Income Details
How Many Adults Live in Your Household?*
How Many Children Live in Your Household?*
Adjusted Gross Household Income for 2022*
Estimated Gross Household Income for 2023*
If you anticipate that your household income this year will be lower than your household income last year, please explain why:
Name of Child*
Age*
Birth Date*
Please add any other information that would be helpful for us to know:
Your Child's Academic Enrichment Program Information
Academic Enrichment Program in Which Your Child Participated*
Link to Program Description (if available)
2nd Academic Enrichment Program (if applicable)
Link to 2nd Program Description (if applicable)
3rd Academic Enrichment Program (if applicable)
Link to 3rd Program Description (if applicable)
4th Academic Enrichment Program (if applicable)
Link to 4th Program Description (if applicable)
Description(s) if no link(s) available:
Total Cost of Program(s)*
Proof of Payment for Each Program Listed*
Drop files here or

Max. file size: 50 MB.
VERY IMPORTANT: Please Read and Check Off the Following
This section is required.*
- I certify that everything in this application is accurate, to the best of my knowledge.
- I will provide HUCTW with the first page of my most recent 1040 form from my federal tax return. (If you and your partner/spouse report your taxes separately, please include her/his/their 1040 form as well, and write your name at the top so we know to include it with your application.) I understand that my application is not considered complete without this tax form(s).

Personal Information

Household and Income Details

Your Child's Academic Enrichment Program Information

VERY IMPORTANT: Please Read and Check Off the Following