• 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
less than two weeks before the upcoming semester start date 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. Once you have completed
all necessary information, you will need to schedule an appointment with
Student Development before returning the form to the CCC Financial Aid Office. If
you are unable to meet with them in person, please call to schedule a phone
conference with their office. Additional
information may be requested.
Please follow the instructions below.
Instructions:
– Fill out page two – Lost Eligibility Worksheet by completing your name, your
Social Security # and your MyCayuga
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.
– Fill out page three – Waiver Request Form by completing name, Social Security # and your MyCayuga ID #, address, whether it is
for State or Federal Aid and sign the waiver.
– 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.
– 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.
– 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 MyCayuga account. 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 _______________________________________________________________________
MyCayuga
ID# ___________________________________________________
– 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.
– NOTE:
Leaving school or dropping classes in order to work is not grounds for a
waiver.
– Waivers
requiring documentation are only granted for circumstances beyond the student's
control.
– A waiver may
be granted only once for any particular situation.
– If your
academic record indicates that you will be unable to complete your degree by
the time you have attempted 90 credits, you will generally not be eligible for
a waiver.
– If you have
questions on completing this form, contact the Financial Aid Office at (315)
255-1743 ext. 2470.
– Many factors
must be considered when evaluating a waiver request. NOT ALL WAIVER REQUESTS WILL BE
APPROVED!
Federal and/or State Aid
last year due to my illness, accident or a 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
you lost eligibility and since you last
received
financial aid. If you have
taken any courses since you lost eligibility, you must pass
all courses
attempted with a 2.0 GPA for that semester, no withdrawals, no F's and no
incomplete grades. 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,
no F's and no incomplete grades. (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
____________________________________________________________________
MyCayuga 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:
– I must
fulfill the minimum standards required for continued receipt of financial aid or
– 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 Financial Aid Committee
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 ______________________________________________________________________________
MyCayuga ID# _______________________________________________________
Student
Signature _________________________________________________ Date ___________________
This
form should NOT be used for chronic illnesses or for conditions which
were
present prior to the semester for which you are seeking a waiver.
---------------------------------------------------------------------------------------------------------------------------------------
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
___________________________________________________________