Get Dimer Program Application Form - Jefferson

Completing the DIMER Program Application Form for Jefferson is a critical step for individuals seeking admission to the Jefferson-Delaware Medical Education Program. This guide provides clear instructions to help users fill out the form accurately and efficiently.

Follow the steps to successfully complete your application.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering your full name in the designated fields for last name, first name, and middle name.
3. Provide your permanent address, ensuring that you fill in the street, city, state, and zip code accurately.
4. If applicable, enter the name and permanent address of your parent, guardian, or spouse, including all required fields.
5. In the 'Statement of Residency' section, indicate the name and relationship of the person who contributes to your support for federal income tax exemption.
6. Complete statements 2 and 3 based on your financial dependency status. If you are financially independent, answer these questions accordingly.
7. For statement 2, provide the dates you have maintained a domicile and continuous residence in Delaware.
8. In statement 3, enter the latest year you filed a Delaware State Income Tax return and specify whether you are a resident or non-resident.
9. Indicate if you plan to file a return for the current year and provide the state where you are a registered voter and where you are employed.
10. Certify that the residence status information provided is correct by signing and dating where indicated.
11. Fill in the name and location of the undergraduate college you attended.
12. Finally, certify the accuracy of the information submitted in the application by signing where required and adding the date.
13. Once you have completed all sections, save your changes, and choose to download, print, or share the form as needed.

Complete your DIMER Program Application Form online today to ensure your application is submitted on time!