Mattapan/ Greater Boston Technology Learning Center

24 Regis Road, Mattapan, MA  02126

(617) 298-0357

Financial Aid Eligibility Form

   

Please provide the following contact information:

First Name
Last Name
Street Address
Apt.
City
State
Zip Code
Cell Phone
Home Phone
E-mail

Date of Birth:

Social Security Number:

Are you currently receiving any of the following benefits:

MassHealth or Medicare/ Medicaid?  

 Yes No

Transitional Assistance?  

 Yes No

Food Stamps?  

 Yes No

Unemployment?  

 Yes No

 

Are you currently working?

Yes No

How many hours a week do you work?

Full Time
Part Time
Self-Employed

Enter the name of your employer:


Enter your work phone number:


Enter your estimated monthly income:

$

What is your household size:


If you are self-employed, what was your income last year:

$

 

* Proof of benefits will be requested..  A card representing the benefit(s) you receive will cover this requirement.

** The information collected by the Mattapan Technology Learning Center will be used only determine your eligibility to receive financial aid assistance through MTLC.  This information will not be shared with any 3rd party including state and/ or federal agencies.

 

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Revised: April 30, 2009