FND Stipend Form (One Time)
You are being provided a stipend for your work above and beyond your hired Mass General Brigham (Brigham and Women’s Hospital or Mass General Hospital) scope. To receive funding from the FND, you must be a US citizen or permanent resident. FND stipends are taxable to you, and you will receive a Form 1099 NEC - non-employee compensation for which you must report to the IRS. You will be responsible for federal and state taxes and self-employment taxes. Payments are mailed the last week of the month worked. If any questions, please contact LaShaunda Gayden and Janelle Weathers.
Grantee Name
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First Name
Last Name
Best Phone Number
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Please enter the best phone number.
Format: (000) 000-0000.
Personal Email
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Please enter personal email address.
Current Address (where check should be mailed)
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Street Address
If applicable, enter apt, suite, unit, floor, etc.
City
State / Province
Postal / Zip Code
Please upload required W-9 Form here.
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One-Time Grant Amount ($)
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FND Account
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Start Date
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End Date
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Summary of work to be performed:
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I attest that all transactions are valid.
Grantee Signature
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Account Holder Signature
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ARCND Co-Director Signature 1
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ARCND Co-Director Signature 2
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