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LAMONT-DOHERTY CHILD DEVELOPMENT CENTER APPLICATION FOR TUITION ASSISTANCE: PLEASE PRINT
 

Summary: LAMONT-DOHERTY CHILD DEVELOPMENT CENTER
APPLICATION FOR TUITION ASSISTANCE: PLEASE PRINT
CONFIDENTIAL
APPLICANT
NAME________________________________
AFFILIATION:
Lamont-Doherty ( ) CIESIN ( ) IRI ( ) Columbia NYC ( ) Other ( )
POSITION_____________________________ E-MAIL_______________________
TELEPHONE NUMBERS: Home_________________ Work__________________
HOME ADDRESS_____________________________________________________
_____________________________________________________
_____________________________________________________
NAME OF CHILD #1 _______________________________ DOB_____________
NAME OF CHILD #2 _______________________________ DOB_____________
RELATIONSHIP TO CHILD[ren]_________________________________________
FINANCIAL INFORMATION:
You must provide: Copy of most recent IRS Tax Return and W2's
Completed IRS Form 4506-T
I certify that the information provided above, and financial documentation provided in
support of this application is, to the best of my knowledge, accurate and complete.

  

Source: Anchukaitis, Kevin - Lamont-Doherty Earth Observatory, Columbia University

 

Collections: Environmental Sciences and Ecology; Geosciences