Aspire Financial Aid Application 2017-18– Page 1

Financial Aid Application 2017-18

Thank you for your interest in Aspire’sprograms. Please complete the following instructions to be considered for financial aid. Financial aid applications will not be reviewed unless all required documents are attached and the application form is complete.

A complete application includes:

A completed financial aid application

Copy of current (2016) completed IRS 1040 Forms with all schedules

W-2 Forms (2016) for each working family member living in household

Last 2 pay-stubs for each working family member living in household

Important Information regarding Financial Aid

Qualification for Aid

Financial aid is awarded based upon the availability of resources and applicant qualifications. Financial aid is based on several different criteria including family income, size of family, etc. Submittal of financial aid application does not guarantee aid. Financial aid will be awarded after the applicant has been accepted to the program.

Applicants Over 18

If the applicant is over 18 and lives with a parent/legal guardian, we require that both the participant as well as the parents/legal guardians provide application materials. If you do not provide this information, the financial aid application will be considered incomplete.

Returning Applicants

A new financial aid application must be submitted each year. We reserve the right to ask for updated tax information after April 15th to make a final determination for financial aid requests if you are applying for one of our summer programs.

Please Submit Your Application Via:

Email
/ Fax
781-860-1920 / Mail
MGH Aspire
1 Maguire Road
Lexington, Massachusetts 02421
Please contact us at 781-860-1900 or email us at if you have any questions.
Thank you for your application!
Aspire Participant Information
First Name: / Last Name:
City: / DOB: / MGH MRN:
Financial Aid Application Contact Information
First Name: / Last Name:
Home Phone: / Cell Phone: / Email:

Total members in household:

Total household income:

Family Information
List all people (including extended family and stepparents) who live in the household with the applicant.
Full Name: / DOB: / Relationship to Applicant:
Other Income
Please list any other income your family receives. This can include the following but is not limited to:
• Alimony• Dividends or Interest• Retirement
• Unemployment Compensation• Annuities• Pensions
• Social Security• Worker’s Compensation• Child Support
• Rental Income• Veteran’s benefits• Medicare
Name of Recipient: / Type of Income: / Monthly Amount Before Taxes:
IncomeInformation
Please complete this section regarding income, before taxes and deductions, for yourself and each person in the household that works.
Family Member / Employer Name / Type of Work / Pay Before Deductions / Paid
Full-time
Part-time
Per-diem
Temporary / Weekly
Bi-weekly
Monthly
Full-time
Part-time
Per-diem
Temporary / Weekly
Bi-weekly
Monthly
Full-time
Part-time
Per-diem
Temporary / Weekly
Bi-weekly
Monthly
Full-time
Part-time
Per-diem
Temporary / Weekly
Bi-weekly
Monthly
Application Signatures
I certify that what is stated on this form is correct and accurate. I understand that by signing below I am giving Aspire permission to verify employment information listed above. I understand that Aspire cannot share confidential information, such as the information contained on this application, with any state or federal agency without my prior approval. I also understand that this application form will not be included in the applicant’s medical file.
If applicant is 18 years or older:
Applicant Signature
I give permission for Aspire staff to communicate with my parents/legal guardians regarding this financial aid application / Date:
Yes
No
If applicant is under 18 years of age:
Parent/Guardian Signature / Date:

1 Maguire Road, Lexington, MA 02421 | Tel 781-860-1900 | Fax 781-860-1920 |