Financial Aid Application Form printable pdf download

The C enter f or t he P erforming A rtist a t

NewYork-‐Presbyterian H ospital/Weill C ornell M edical C enter

Charity C are/Financial A id A pplication F orm

Please c omplete t he a pplication a nd a ttach a ll r equired d ocuments a nd s ubmit t o t he a dministrative

office o f t he C enter f or t he P erforming A rtist i n a dvance o f y our v isit. I f r elevant d ocumentation

listed b elow i s n ot p rovided o r y our a pplication i s i ncomplete, w e w ill b e u nable t o p rocess y our

application.

To f urther a ssist u s i n p rocessing y our a pplication f or f inancial a id p lease p rovide c opies o f t he

documents i ndicated b elow w hich a pply t o y our p articular s ituation.

IRS f orms: W -‐2 o r 1 099

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Tax R eturn: U .S. F ederal f orm 1 040 o r C ountry o f C itizenship

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Last 3 P ayroll S tatements o r U nemployment B enefits S tatements ( evidence o f s tart d ate)

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Social S ecurity A ward l etter

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Mortgage P ayment/Rent R eceipt a nd/or L etter f rom w hoever p ays t he r ent o r m ortgage

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Most R ecent B ank a nd/or B rokerage S tatements

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Any M edicaid a nd/or H ealth B enefits A cceptance o r D enial L etter

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Any D ocument t hat r elates t o i nformation p rovided o n t he a pplication’s s ignature p age, f or

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example: F ood S tamps, P ublic A ssistance, S elf E mployment

If y ou a re u nder 2 1 ( Twenty-‐one) y ears o f a ge, a nd/or y ou a re a d ependent o f y our

parent(s)/guardian(s), t hen y our p arent o r g uardian m ust f ill o ut t he e ligibility a pplication f orm

entitled A PPLICATION F OR F INANCIAL A ID A ND S LIDING F EE S CALE a nd p rovide t he n ecessary

supporting d ocuments.

A p hone n umber w here y ou c an b e r eached M UST B E P ROVIDED, a s w ell a s c omplete a ddresses,

including a partment n umbers a nd l etters.

A n ote d escribing y our s ituation m ay a lso b e h elpful, b ut c opies o f t he d ocuments l isted a bove w hich

apply t o y our s ituation a re n ecessary t o d etermine y our o r y our c hildren’s e ligibility.

If y ou a re a s tudent, p lease p rovide d ocumentation o f y our s tudent s tatus.

NOTICE T O P ATIENTS

IF Y OU S UBMIT A C OMPLETED A PPLICATION I NCLUDING I NFORMATION O R D OCUMENATION

NECESSARY T O D ETERMINE E LEGIBILITY U NDER T HE M EDICAL C ENTER’S P OLICY, Y OU M AY

DISREGARD A NY M EDICAL C ENTER B ILL U NTIL W E H AVE M ADE A D ECISION O N Y OUR

APPLICATION.

The C enter f or t he P erforming A rtist a t

NewYork-‐Presbyterian H ospital/Weill C ornell M edical C enter

Financial Aid Application Form