College Change Request printable pdf download

CHANGE REQUEST 2015-2016

SRSU Title IV Code: 003625

Student’s Name: _____________________________________ ID:__________________

Email: ____________________________________________ Phone: ________________

I am requesting the following changes to my financial aid application for the semester(s) indicated below -

INDICATE THE NUMBER OF HOURS YOU PLAN TO BE ENROLLED IN - DO NOT USE CHECK MARKS OR CIRCLE TERMS.

# of hours enrolled in Fall____ / # of hours enrolled in SPRING ____ / # of hours enrolled in SUMMER I ____ / # of hours enrolled in SUMMER II ____

Loans

Increase loan by $________ to total = $_______

Decrease loan by $________ to total = $_______

Subsidized Direct Loan

Accept full loan offer amount

Cancel loan offer

Increase loan by $________ to total = $_______

Unsubsidized Direct Loan

Decrease loan by $________ to total = $_______

Accept full loan offer amount

Cancel loan offer

Other Aid

Work Study

Decrease to ___________

Award

Cancel

Reason for change:

Will not attend SRSU Term: __________

Change in number of hours of enrollment

Change in classification to _____________

Other __________________________________

Child Care Expense (a completed Dependent Care Verification Form must accompany this form)

CERTIFICATION:

I fully understand that the Financial Aid Office will evaluate my request AND that this request may be denied.

My signature also indicates my acceptance of the award that may result from this request and authorizes the University to apply any scholarship, grant, or

loan proceeds received by electronic funds transfer (EFT) or otherwise to my student account for payment of my tuition, fees, room, board, and any other

University debt.

_________________________________________________

________

S tudent’s S ignature

D ate

SUBMIT YOUR REQUEST TO SRSU FINANCIAL AID OFFICE OF THE CAMPUS YOU ARE ATTENDING:

Center for Enrollment Services

Office of Financial Aid

P.O. Box C-2

3107 Bob Rogers Drive

2623 Garner Field Road

205 Wildcat Drive

Alpine, TX 79832

Eagle Pass, Texas 78852

Uvalde, TX 78801

Del Rio, TX 78840

Phone: (432) 837-8050

Phone: (830) 758-5021

Phone: (830) 279-3008

Phone: (830) 703-4824

Fax: (432) 837-8411

Fax: (830) 758-5019

Fax: (830) 279-3009

Fax: (830) 703-4810

E-mail: fa@sulross.edu

E-mail: rgcfao@sulross.edu

State law requires that you be informed of the following: (1) you are entitled to request to be informed about the information about yourself collected by use of this form (with a few exceptions as provided by

law); (2) you are entitled to receive and review that information; and (3) you are entitled to have the information corrected at no charge to

you.

FOR OFFICE USE ONLY

Fall _____

Spring _____

Summer I _____

Summer II _____ Original Grade Level _____ New Grade Level_____

EFC ______ Original Budget _______ Revised Budget ________ Aid _______ SAP _______ Status I or D

Reason for change:

Increase in hours

Decrease in hours

Plus Denial on File