Economically Disadvantaged Waiver Award for Fall 2012 $400

Please complete the application, documentation materials, and return to USU Moab Center on or before Tuesday, August 21, 2012.
This Economically Disadvantaged Waiver may be awarded to students whose abilities to afford college have been impaired due to diminished family income and/or extreme financial stressors. Students with the lowest Estimated Family Contribution (EFC) numbers on their Student Aid Report (SAR) will be given first consideration. In the event of a tie, the applications that were submitted first and initialed by an USU represented will be considered in submission order. Criteria: Applicants must meet institutional admission requirements and be admitted to Utah State University to be considered Awarded students agree to have a registration hold placed on their account at time of award. Any changes to a students registration after the award date must be coordinated with the USU Moab advisor. The award will be completely reversed if attempted credit hours fall below six credits during the term. Economically Disadvantaged Waivers are available only to students who qualify for Federal Financial Assistance Award renewable for Spring 2013 if student maintains a 2.75 GPA for the Fall 2012 semester Students (graduate or undergraduate) must enroll in 6 or more credits Students must enroll for Moab class sections (online, face-to-face, or interactive video conferencing) This award is not redeemable for cash Waiver cannot be used with any other USU sponsored scholarship or waiver You can be a new or returning student to USU Moab Accompanying documentation to be included with the application: Copy of your current FAFSA Student Aid Report (SAR) Documentation that you have been admitted to Utah State University A Number ______________________________ ( ) ___________________________

Name: _______________________________________ E-mail: _____________________________ Phone:

I certify the information provided on this application is correct to the best of my knowledge and I authorize the release of this information and/or my transcripts to anyone or institution involved in the awarding of the above waiver.

Signature

Date

December 21, 2011

(Official Use Only) Date Received by USU ____________________ Initials USU Representative ____________________