Duxbury Bay Maritime School

2017 Financial Aid Application

Financial Aid is limited to One Class per Season per Student and

Limited to Youth through age 18

All of the following must be submitted at least two weeks prior to program start date to be considered:

   Completed Financial Aid Application

All information will be held confidential.

  1. Parent/Guardian Name(s): _______________________________________________________________

  1. Children’s Name(s):              Age:   Classes Requested (if any) Include dates & times

______________________   ____   _________________________________________________ □ None

______________________   ____   _________________________________________________ □ None

______________________   ____   _________________________________________________ □ None

______________________   ____   _________________________________________________ □ None

  1. Parent/Guardian Financial Information                                                                                                        

(If student lives with one parent or guardian, provide information for parent/guardian with custody over student).

  1. Gross Monthly Earnings (before deductions)                $________________
  2. Monthly Welfare, Child Support, Alimony Payments         $________________
  3. Monthly Pension, Retirement, SS Payments                $________________
  4. Any Other Monthly Income                                $________________

  1. Student’s Financial Information (if applicable)

Outside Employment (List both full and part-time jobs held at any time during the past 12 months).

Company Name                          Occupation                          #of hours/wk                  Take home pay        Total Pay

__________________________________________________________$_______________$_________

__________________________________________________________$_______________$_________

__________________________________________________________$_______________$_________

__________________________________________________________$_______________$_________

__________________________________________________________$_______________$_________

  1. Explain any special circumstances, such as illness, age, unusual expenses, etc. which may make it difficult for you or your family to pay for the course fees.  Where necessary, attach a copy of documentation or proof of your claim.

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

___________________        ____________________________________________________________

Today’s Date                        Signature of Parent/Guardian

___________________        ____________________         ___________________________________

Home Telephone                Work Telephone                 Email

Mail to: Beth Casey, Duxbury Bay Maritime School P.O. Box 263A  Duxbury, MA  02331

Or drop off at the DBMS office at 457 Washington Street, Duxbury  Attn:  Beth Casey