CAYUGA
COMMUNITY COLLEGE
Financial Aid Office · 197 Franklin Street,
Auburn, NY 13021
Auburn 315-255-1743 · Fulton 315-592-4143 · FAX 315-252-2185
Lost Eligibility Worksheet and Waiver
Request Form
Waivers that are turned in
after ___________________________ will not
be processed in time to be used as a deferral towards tuition and fees. You will be responsible for payment after
this date.
Instructions:
ü Fill out page two – Lost Eligibility Worksheet by completing your name, SS# and Banner
ID. Choose the appropriate
explanation. If none of these reasons
applies to your situation, a waiver probably WILL NOT be granted. Keep in mind that some options require
documentation or an explanation of the circumstances. Waivers requiring documentation are only
granted for circumstances beyond the student’s control. Please note: leaving school or dropping
classes in order to work is not grounds for a waiver. You cannot use the same reason for more
than one waiver except for reason #5.
ü Fill out page three – Waiver Request Form by completing name, SS# and Banner ID, address,
whether it is for State or Federal Aid and sign the waiver.
ü Fill out page four – Authorization for Release of Health Records only if there
was a medical reason. Give this page to
your medical provider to complete and return to our office.
ü After you have completed pages two and three (and page
four if applicable) make an appointment with a Student Development Counselor to
review and sign your Waiver Request Form.
Waivers will not be processed without a signature from their
office.
ü If Student Development signs your Waiver Request Form, return all pages to the Financial Aid Office
for approval. You will be able to check
the status of your waiver by logging in to your Banner account. It takes five to seven days to receive
notification.
A waiver may
be granted only once for any particular situation.
Please Note: If none
of the reasons on page two applies to your situation,
a waiver probably
WILL NOT be granted.
For more complete information on
maintaining aid eligibility please consult the
CCC website at: www.cayuga-cc.edu.
· CAYUGA COMMUNITY COLLEGE ·
Financial Aid Office · 197 Franklin Street,
Auburn, NY 13021
Auburn 315-255-1743 · Fulton 315-592-4143 · FAX 315-252-2185
Lost Eligibility Worksheet
To
be returned to Financial Aid
Name ______________________________________________ SS#______________________________
Banner ID#
_________________________________
Ø Check the
appropriate explanation. If none of these reasons applies to your situation,
a waiver probably WILL NOT be granted.
Please note: You cannot use
the same reason for more than one waiver except
for reason
#5.
Ø NOTE:
Leaving school or dropping classes in order to work is not grounds for a
waiver.
Ø Waivers
requiring documentation are only granted for circumstances beyond the student’s
control.
Ø A waiver may
be granted only once for any particular situation.
Ø If you have
questions on completing this form, contact the Financial Aid Office at (315)
255-1743 ext. 2470.
Federal and/or State Aid
last year due to illness, accident or
death in the family.
REQUIRES DOCUMENTATION: For illness or accident, have your
physician complete the
enclosed
confirmation form. Do not submit actual medical records.
For a death in the family,
attach a
death certificate or copy of the obituary along with an explanation of your
relationship
to the deceased. Waivers for extenuating circumstances will
not be granted for consecutive
semesters.
2. ____ I was a student at CCC over a year ago with a poor academic record
and now realize the
importance of a college education.
NOTE:
Two (2) full semesters must have passed since your last attendance.
Write a letter explaining the circumstances
of your withdrawal from CCC and what has
changed to
make you believe you can now be successful.
Federal Aid ONLY
3.
____ Other extenuating
circumstances beyond the student’s
control.
REQUIRES OFFICIAL DOCUMENTATION
from a source other than the student.
The documentation must prove that (1) the
situation occurred and (2) that it is unlikely to recur.
Waivers
for extenuating circumstances will not be granted for consecutive semesters.
4. ____
I am in a second degree program that has been approved by the Student
Development Office.
(Note: Current
degree evaluation must be attached).
Generally there is a 2 semester maximum for
completing a second degree.
5. ____ I
previously attended CCC without successfully completing the required number of
credits.
However, I have just completed a semester of 6 credits or more with a 2.0 GPA for
that semester,
no withdrawals
and no F’s. (Attach grade report from prior semester).
· CAYUGA COMMUNITY COLLEGE ·
Financial Aid Office · 197 Franklin Street,
Auburn, NY 13021
Auburn 315-255-1743 · Fulton 315-592-4143 · FAX 315-252-2185
Waiver Request Form
New York State and Federal Student
Financial Aid
Before completing the Waiver Request Form, a student
should read and complete the Lost Eligibility Worksheet.
1.
To be completed by student:
Name
__________________________________________________________
Social Security #
_______________________________ Banner
ID # _________________________
Address
______________________________________
Phone # ____________________________
City
_____________________________ State
___________ Zip code
______________________
I request a waiver for: ________ State Aid ________ Federal Aid
I understand that a waiver may be granted only once
for New York State awards and only twice for Federal awards. I also recognize that at the end of the
semester for which the waiver is granted:
ü I must
fulfill the minimum standards required for continued receipt of financial aid or
ü I may apply
for an extension of my waiver if I was registered for 6 or more credits and
completed all credits, (no F’s, or W’s), with a 2.0 GPA or higher.
Student Signature
_______________________________________________ Date
______________
2. To Be
Completed by Student Development Counselor
I have reviewed this waiver
request. Based upon the documentation
provided (if required) and my evaluation of this student’s potential for
academic success, I recommend:
Approval _______ Disapproval
_______
of this request.
Counselor Signature
_____________________________________________ Date
______________
3.
To be Completed by the Director of Financial Aid
Based on the documentation
provided and the counselor recommendation, this request is:
Federal: Approved
_____ Denied _____ State: Approved _____ Denied _____
Comments and conditions
______________________________________________________________
____________________________________________________________________________________
Date____________________________
· CAYUGA COMMUNITY COLLEGE ·
Financial Aid Office · 197 Franklin Street,
Auburn, NY 13021
Auburn 315-255-1743 · Fulton 315-592-4143 · FAX 315-252-2185
Authorization for Release of Health
Records
(To be completed by student)
Student
Name ______________________________________________________________________________
Social
Security # _______________________________ Banner
ID # _______________________________
Student
Signature _________________________________________________ Date ___________________
---------------------------------------------------------------------------------------------------------------------------------------
Confirmation of illness/accident
(To be completed by your physician)
I
certify that ___________________________________________________________ was
treated by me
from
(date) _____________________________ to ______________________________ due to
illness,
accident
or complications of pregnancy. (NOTE:
normal pregnancy should not be included.)
Please check both if they apply:
_______ During this period of time the student was
unable to attend classes.
_______ The student is now able to return to classes.
Additional Comments
_____________________________________________________________________________________
_____________________________________________________________________________________
Physician
signature _______________________________________________________
Physician
printed name ____________________________________________________
Physician
phone number ___________________________________________________
Date
___________________________________________________________