Delaware Academy of Medicine - Student Financial Aid Application Form 2023

P.O. Box 89 Historic New Castle, DE 19720

302-733-1122

Students Application

FIRST - Choose your Student Loan Program below, either Health Care Student Loan Program or Physician and Dentist Loan Program.

Applicant Demographics

Free or lower-cost Title IV federal, state, or school student financial aid may be available in place of, or in addition to, a private education loan. To apply for Title IV federal grants, loans and work-study, submit a Free Application for Federal Student Aid (FAFSA) available at studentaid.gov, or by calling 1-800-4-FED-AID, or from the school’s financial aid office.

First Name

Complete Middle Name

Last Name

Other

I Identify as:

Student ID

Email Address

Phone Number

Permanent Address

Street

Apartment/Lot/PO Box

City/Town

State/Province

5 digit Zip/Postal Code

Country

Are you a U.S. Citizen

YesNo

If you answered "No" to previous question, are you a Permanent Resident?

YesNo

If you are a Permanent Resident, please provide a scanned photocopy of both sides of your I-151 or I-551

card.

Are you a Delaware Resident?

YesNo

How long have you been a Delaware resident?

Date of Birth

Place of Birth

Social Security Number

Applicant's Marital Status and Dependents

Marital Status

SingleMarriedDivorcedOther

Other(Please Specify)

Spouse Name ( If you are married please enter Spouse Name )

Spouse Employer

Spouse Occupation

Parent/Guardian Information

First Parent/Guardian Information

MotherStepmotherLegal Guardian

First Name

Full Middle Name

Last Name

Occupation

Title

Address

City/Town

State/Province

ZIP/Postal

Employer

Phone Number

Second Parent/Guardian Information

FatherStepfatherLegal Guardian

First name

Full Middle Name

Last Name

Occupation

Title

Address

City/Town

State/Province

ZIP/Postal Code

Employer

Phone Number

Applicant Education Information

High School

Name

Address

City/Town

State/Province

ZIP/Postal Code

Country

Graduation Date

Field of Concentration (if any)

College

Name

Address

City/Town

State/Province

ZIP/Postal Code

Country

Major

Degree(s) earned:

Graduate Date

First Year and First Time Applicant Section

Are you a first time applicant?

First-time applicants must complete this section and upload required documentation. Any incomplete or incorrectly submitted information or documentation on this application will cause it to be dismissed this cycle.

Proof of Delaware residency is applicable to first time applicants only. First time applicants must provide an official copy of their signed

Delaware tax return (either your personal return, or if you are a dependent, your parent/guardian's return) for the prior year AND one

the following items:

- Delaware driver's license or state identification

- Delaware vehicle registration

- Delaware voter's registration card

Delaware tax return

Additional proof of residency. Please provide a scanned copy of your Delaware drivers license/state identification card, Delaware vehicle

registration, or Delaware voter's registration.

Proof of Citizenship (Non expired Passport, Birth Certificate or Permanent Resident card)

Credit/Background Check Authorization Document and Upload

I have been accepted at:

Institution Name

Institution Address

Institution City/Town

Institution State/Province

Institution 5 Digit ZIP/Postal Code

Country

Expected completion date:

Expected degree upon training completion:

Other expected degree upon training completion:

Please upload an official copy of your Letter of Acceptance

Are you enrolled as a full-time student?

YesNo

Re-Applicant Section

The definition of a "re-applicant" is a student who has previously received a loan award from the Delaware Academy of Medicine.

Current Institution Information

Current Institution Name

Address

City/Town

State/Province

5 Digit ZIP/Postal Code

Current training year

Expected completion date:

Expected degree upon training completion:

Are you enrolled as a full-time student in good standing?

YesNo

Please upload an official letter from your school, stating you are enrolled for the upcoming year.

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Applicants may apply for the maximum amount available from the Delaware Academy of Medicine for that application year. For example,

in 2020, the maximum amount available per applicant was $12,000.

How much financial aid are you applying for?

Applicant Certification

If you are awarded a loan, it is your intention to use the loan to complete the course of study leading to a degree in:

Please upload your Applicant Self-Certification Form here.

I agree to notify the Delaware Academy of Medicine in writing (by certified US post or via email) immediately if I leave school for any reason prior to graduation. I further agree to provide the Academy with a written progress report of my studies at the end of each academic year.

I submit that the information on this form is true and complete to the best of my knowledge. The Delaware Academy of Medicine reserves the right to request proof of any information provided on this application.

Signature

Date

Delaware Academy of Medicine - Student Financial Aid Application Form 2023 P.O. Box 89 Historic New Castle, DE 19720 302-733-1122

First-time applicants must complete this section and upload required documentation. Any incomplete or incorrectly submitted information or documentation on this application will cause it to be dismissed this cycle.

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Delaware Academy of Medicine - Student Financial Aid Application Form 2023

P.O. Box 89 Historic New Castle, DE 19720

302-733-1122