Form EDUC-1 "Educational Income and Expense Form" - Massachusetts

What Is Form EDUC-1?

This is a legal form that was released by the Massachusetts Department of Transitional Assistance - a government authority operating within Massachusetts. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on August 1, 2017;
  • The latest edition provided by the Massachusetts Department of Transitional Assistance;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form EDUC-1 by clicking the link below or browse more documents and templates provided by the Massachusetts Department of Transitional Assistance.

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Educational Income and Expense Form
Massachusetts Department of Transitional Assistance
You may give us your verifications in any of the following ways:
 Mail your verifications to: DTA Document Processing Center,
P.O. Box 4406, Taunton, MA 02780-0420
 Fax to (617) 887-8765
 Upload to the DTA Connect App
 In person at your local DTA office.
________________________________________ _____________________________________________________________________
 
or last 4 of SSN
Head of Household Name
Head of Household Agency ID
 
Part A For the Student: Complete and give to the Financial Aid Office.
____________________________________________
_______________________________________
Student Name
Student Date of Birth
____________________________________________________________________________________________________
Name of School
Student Authorization
I authorize my school to give information about my financial aid to the Department of Transitional Assistance.
The Financial Aid Office may continue to give DTA information that might affect my public assistance
throughout the school year.
__________________________________________________________
____________________
Student Signature
Date
EDUC-1 (Rev. 8/2017)
Page 1 of 2
02-122-0817-05
Educational Income and Expense Form
Massachusetts Department of Transitional Assistance
You may give us your verifications in any of the following ways:
 Mail your verifications to: DTA Document Processing Center,
P.O. Box 4406, Taunton, MA 02780-0420
 Fax to (617) 887-8765
 Upload to the DTA Connect App
 In person at your local DTA office.
________________________________________ _____________________________________________________________________
 
or last 4 of SSN
Head of Household Name
Head of Household Agency ID
 
Part A For the Student: Complete and give to the Financial Aid Office.
____________________________________________
_______________________________________
Student Name
Student Date of Birth
____________________________________________________________________________________________________
Name of School
Student Authorization
I authorize my school to give information about my financial aid to the Department of Transitional Assistance.
The Financial Aid Office may continue to give DTA information that might affect my public assistance
throughout the school year.
__________________________________________________________
____________________
Student Signature
Date
EDUC-1 (Rev. 8/2017)
Page 1 of 2
02-122-0817-05
____________________________________ _______________________________________________________________
Student Name
Head of Household Agency ID or last 4 of SSN
Part B: For the School: Complete and send directly to DTA.
1. Student’s Financial Aid is for this enrollment period: ___________ Academic Year
_____ Fall _____ Spring _____ Summer _____ Other (from _______ to _______)
2. Program Type: _____ Associate _____ Bachelor _____Graduate
_____ Certificate
_____________________ Other
(specify)
3. Expected Date of Graduation: ________________________
4. Enrollment Status:
______ ½ time or more
______ less than ½ time
5. Does this student receive financial aid through a MASS Grant?
____YES ____NO
6. Does this student participate in federal work study during the school year?
____YES ____NO
NOTE: “Yes” must only be designated if the student is actively participating in federal work
study. If the student was awarded federal work study but is not actively participating in
federal work study (for example, a position has not been designated), “No” must be
.
designated
1
7. Does this student receive non-federal grants, loans or scholarships?
____YES ____NO
8. Does this student live on campus?
____ YES ____ NO
a.) If YES: How much is this student charged for living expenses (room and board)? $________
b.) Does the student have a meal plan designated to cover 2/3 of their meals?
____YES ____NO
c.) Is any portion of living expenses covered by a non-federal funding source?
____YES ____NO If YES: How much? $ ___________________
________________________________________
_______________________________
_____________________
School
Telephone
Date
__________________________________ _____________________________________________________________
Financial Aid Office Signature
Print Name
1
Including, but not limited to, Gilbert Grant, MA Performance Bonus, MA No Interest Loan, MA Part-time or Cash Grant, and
Institution Grants.
This institution is an equal opportunity provider.
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