Financial Aid Application

2024-2025
Geisel School of Medicine

The policy of the Geisel School of Medicine is to support equality of opportunity for persons, regardless of race or ethnic background. No student will be denied financial aid, or be otherwise discriminated against, because of age, disability, race, color, sexual orientation, religion, sex, or national or ethnic origin. Federal regulations governing Title IV programs require United States Citizenship or Permanent Resident status as a stipulation for eligibility for federal aid. This form is required for all students applying for any type of financial aid from the Geisel School of Medicine.

Entries marked with * are required.

I. Applicant Information
Last Name*:
First Name*:
Middle Name:
Preferred Name*:
Student ID:	If you are a returning student, please enter your student ID
Permanent Address*:
City*:
State*:
Zipcode*:
Mailing Address*:
City*:
State*:
Zipcode*:
Phone Number*:
Email Address*:
Date of Birth*:
Place of Birth*:
Citizenship*:
Date FAFSA filed:
Date PROFILE Submitted:	First time applicants only
Eligible Non Citizen (for non US Citizens):	Yes No
If you are a US military veteran, are you planning to use military benefits this year:	Yes No
Number of dependents*:	include self, spouse & children
2024-2025 Year in school at Geisel*:
Undergraduate School Attended*:
Years attended, from:	i.e. from 9/10 ...
To:	... to 6/12
Program you were enrolled in:
Did you receive Federal Direct/Stafford Loans while enrolled:	Yes No
II. Special Information
Please describe any special circumstances which should be considered in evaluating your request for financial aid*:
Have you identified yourself to AMCAS as an Ohio resident and wish to be considered for the Ohio Scholars Program*:	Yes No
III. Default/Refund Verification
By signing this application, I certify that I am not in default on any Federal Stafford, Federal Perkins, or GradPLUS loan that I received while attending any institution, nor do I owe a refund on any PELL, SEOG, or SSIG grant received for attendance at any institution. I also certify that all the information reported to qualify for federal aid is complete and accurate.
I have read and understood the Default/Refund Verification Statememt*:	Yes
Signature*:
Date:	09/19/2024
IV. Statement of Need/Understanding
I, the undersigned, hereby state that financial aid is essential to enable me to continue my education at the Geisel School of Medicine. As a financial aid recipient, I am expected to notify the Financial Aid Office of any circumstances which significantly improve or diminish my financial resources or those of my family; contribute each year from my savings and/or summer earnings toward my medical school expenses; maintain satisfactory academic progress; and report to the Financial Aid Office any aid received from outside sources. I understand that the information provided on this and other documents may be shared with the government and private agencies from which I am requesting aid, and with scholarship donors if aid is offered and accepted. The information submitted is true and accurate.
I have read and understood the Statement of Need/Understanding*:	Yes
Signature*:
Date*:	09/19/2024