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 Engagement 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 Engagement Counselor to review and sign your Waiver Request Form.  Waivers will not be processed without a signature from their office.

 

If Student Engagement 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

 

  1. ____ I withdrew from a semester (or some classes) at Cayuga Community College within the

        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 Centers for Student Engagement and Academic Advisement.

                  (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 Engagement 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.

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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 ___________________________________________________________