TCC Childcare Scholarship: New Enrollment 2018-2019

Application Form for John Doe — MIT ID 123456789

Job title Start date End date Department Effort % Hours/week Salary
Assistant Professor Apr 12, 2004 Dec 2, 2019 Chemistry 70% — $83,746.00
Assistant Professor Apr 12, 2004 Dec 2, 2019 Physics 30% — $37,128.00

About Me

I am
I'd like correspondence to be sent to
Contact me at

About My Spouse/Partner

My partner/spouse is affiliated with MIT as
My partner/spouse is
Type of Funding
My spouse/partner is paid
My spouse/partner is paid

Attach certification provided by a doctor or a clinic. *

Accepted formats are PDF, JPEG, PNG, GIF. Filesize should be smaller than 2MB.
Accepted formats are PDF, JPEG, PNG, GIF. Filesize should be smaller than 2MB.
Please be aware that this may affect your eligibily for this benefit.

Provide any documents that you feel might help support your application.

About My Children

Validate to not backdate > two months
First Name Last Name Birth Date TCC Center Classroom Days per Week Hours Actions

Estimation of Gross income for Sep 1, 2018 – Aug 31, 2019

$
$
$
$

Total

$

Financial Documentation

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  All documentation must be translated into English.

Documents provided must be supplied in either PDF, Word, PNG, or JPEG format and filesize must be under 3MB.

 

My Financial Documentation

My Spouse's/Partner's Financial Documentation

A completed and signed copy of all pages of last year's Federal Income Tax Form 1040 or 1040A (if filed)

If your or your spouse's/partner's financial documentation originates in a country other than the United States, please supply comparable documentation to demonstrate income.

Copies of two current pay stubs or similar information. If your spouse/partner is self-employed, attach a copy of IRS schedule C and any other proof of self-employment available.

N/A

Studying partner/spouse must include proof of enrollment status and a copy of your appointment letter (if applicable) documenting all sources of funding.

N/A

Additional financial information, if necessary, to explain projected income as described in your estimate of gross, taxable income for the scholarship year.

Statement of Understanding

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