COLLEGE OF PHYSICIANS & SURGEONS DBMI HIT P

COLLEGE OF PHYSICIANS & SURGEONS
DBMI HIT PROGRAM
AID TYPE REQUEST FORM
2016-17
Please Submit This Form If You Plan To Apply For Educational Loans
I AM PLANNING TO APPLY for private, alternative loans. Please indicate the lender(s) and
loan type(s) and amount(s):
___________________________________________________________________
___________________________________________________________________
I have Columbia University tuition benefits. Please indicate amount per term:
____________________________________________________________________
I have tuition benefits from another employer. Please indicate employer and amount per
term:
____________________________________________________________________
I have scholarship aid from external sources. Please provide source(s) and amount(s) per
term:
____________________________________________________________________
____________________________________________________________________
Signature:
_
Date: ___________
Print Name: ______________________________________
CU ID or UNI: _______________________
Cell Phone: ________________________
Return to:
Columbia University – Office of Student Financial Planning
College of Physicians & Surgeons and College of Dental Medicine
th
630 West 168 Street
P&S Box 52-A
New York, New York 10032
http://cumc.columbia.edu/student/finaid
Phone 212-305-4100
Fax 212-305-0221
P:\Applications\2016 Application Materials\Application Materials\AidTypeHIT2016.docx