Other Aid Source Disclosure Form

Other Aid Source Disclosure Form
Federal regulations require students to notify the financial aid office of funding they will receive from certain additional aid
sources and that we consider those funds when calculating student financial aid eligibility. Examples of other aid sources
that must be reported are below. You DO NOT need to report standard veterans benefits (e.g., Chapter 30 Montgomery,
Chapter 31 Vocational Rehabilitation, Chapter 33 Post 9/11) or funding from a 529 College Savings Plan.
STUDENT IDENTIFICATION
________________________________________
____
First Name
__________________
Student ID
OR
M.I.
__________________
_______________________________________________
Last Name
_
(
)
______________________________________
Last 4 Digits of SSN
Phone Number
CHECK THE BOX FOR AND COMPLETE EACH SECTION THAT APPLIES
EMPLOYER REIMBURSEMENT
Employer Name:__________________________________________________________________________________
I have included a copy of my employer’s reimbursement policy
Please complete the following if no policy is included
My employer calculates the amount of tuition funded in the following way:
As a per credit hour rate of $_______________ with:
An annual maximum of $________________
No annual maximum
OR
As a percentage, _______%, of IWU’s tution rate with:
An annual maximum of $________________
No annual maximum
My employer’s policy includes payment for books:
No
Yes, with no limit
Yes, up to $_____________
My employer’s policy includes payment for fees:
No
Yes, with no limit
Yes, up to $_____________
GRANTS AND SCHOLARSHIPS FROM OUTSIDE SOURCES
Funding Source/Grant or Scholarship Name:___________________________________________________________
Please include a copy of the payment guidelines for this funding source
STATE-ADMINISTERED VOCATIONAL REHABILITATION SERVICES AND WORKFORCE DEVELOPMENT
Funding Source:__________________________________________________________________________________
I have included a copy of the payment guidelines for this funding source
Please complete the following if no payment guideline document is included
Total amount awarded by this funding source: $________________
This funding source may be applied to books charges:
No
Yes, with no limit
Yes, up to $_____________
This funding source may be applied to fees:
No
Yes, with no limit
Yes, up to $_____________
STUDENT SIGNATURE (required for faxed, mailed, or hand-delivered forms)
____________________________________________________________________________ ______/______/______
Student Signature
Date
Email, fax, mail, or deliver the completed form to the Non-Residential Financial Aid Office using the contact information listed below
EMAILED FORMS MUST BE SENT FROM THE IWU STUDENT EMAIL ACCOUNT
Financial Aid Office, Non-Residential
800-621-8667 option 4
th
1900 West 50 Street
765-677-2516
Marion, IN 46953-9393
765-677-2030 FAX
indwes.edu
[email protected]