Request For Cost Of Attendance Increase - Psu
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1
2Office of Student Financial Aid and Scholarships
2015-2016
(Please select application year)
Student Name_________________________________
ID#______________________
REQUEST FOR COST OF ATTENDANCE INCREASE
You may request an increase to your Cost of Attendance based on special circumstances. Check the items that apply to
your circumstances and attach all necessary documentation.
CHILD CARE COSTS – an increase for child care expenses. Complete the attached child care provider statement
and attach billing documentation from the start of FALL term forward.
COMPUTER COSTS – an increase up to $1,000 to accommodate the purchase of a computer once during your
degree program. Provide an advertisement for the computer you plan to buy, including image and cost of
computer.
MEDICAL EXPENSES – an increase for your own medical/dental expenses that are not covered by insurance.
Provide a statement from each medical and/or insurance provider showing the dates of service within the stated
school year (September through August) and the amount not reimbursed by insurance. Only expenses for the
student’s treatment can be considered, not bills for other family members.
PSU HEALTH INSURANCE PREMIUM – an increase to include your quarterly premium for PSU’s health
insurance plan (summer is covered by spring term): ___ fall
___ winter
___ spring
TUITION ADJUSTMENT – an increase for actual tuition costs that are greater than the amount estimated in your
Cost of Attendance for the current academic term. If your academic program has a required class schedule, you
must attach a copy of your department’s enrollment plan for the entire academic year. Adjustment requested for:
_____ credits fall _____ credits winter _____ credits spring _____ credits summer
If this request is approved, we will increase your loans to your maximum eligibility. If you would rather have a specific
dollar amount, please indicate that amount here: $__________
It is possible that this request MAY NOT result in additional financial aid.
Please contact the Office of Student Financial Aid and Scholarships to discuss your eligibility.
Portland State University
Phone:
503-725-3461
PO Box 851
Toll Free: 800-547-8887
Portland, OR
FAX #:
503-725-5965
97207-0851
Email:
askfa@pdx.edu
All the information included is true and complete to the best of my knowledge. If asked by an authorized official, I agree
to give proof of the information I have submitted.
Student Signature:______________________________________________________ Date: ______________
COAINC - Department Use Only
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