Financial Aid Office, IWU-National & Global 1900 West 50
th
Street Marion, IN 46953-9393 indwes.edu
800.621.8667 option 4 765.677.2516 765.677.2030 Fax IWUfinaid@indwes.edu
As a student transferring to Indiana Wesleyan University from another school, it is possible that a portion of
your Federal Student Aid eligibility for the 2017-2018 award year has already been awarded. In accordance
with federal regulations, a student typically may receive Federal Student Aid from only one institution at a time.
To ensure that your Federal Student Aid is awarded correctly and in compliance with these federal regulations,
please complete the release information below and present this form for completion at the institution you
previously attended.
To be completed by the student.
Student Information Release:
I, _______________________________________________________________________ hereby authorize
Student Name
_____________________________________________________________________________ to release
Name of Prior Institution Attended
to Indiana Wesleyan University information regarding my enrollment status and Federal Student Aid.
Student Signature:________________________________________________________________________
Last 4 Digits of Social Security Number:____________________________ Date:______________________
To be completed by a Financial Aid Administrator. Please print.
Student Information:
Academic Year Begin Date:_____________________ Last Date of Attendance:_____________________
Academic Year End Date: _____________________
Total 2017-2018 Gross Amounts Disbursed
Federal Direct Loans: Pell Grant (if applicable): $___________________
Subsidized: $____________________ Last Pell Award Period Start Date:________________
Unsubsidized: $____________________ Last Pell Award Period End Date:_________________
Last Loan Disbursement Date:_________________ Last Pell Disbursement Date:__________________
Future Loan Disbursements Cancelled? Yes No Future Pell Disbursements Cancelled? Yes No
Circle One
Circle One
Certifying Administrator Information:
Administrator Name:_________________________________________________ Date:________________
Institution Name:_________________________________________________________________________
Phone:__________________________ Email Address:__________________________________________
Certifying Administrator’s Signature:__________________________________________________________
*** Please fax this completed form to (765) 677-2030. Thank you for your assistance in this matter. ***
AND FEDERAL STUDENT AID
CLEARANCE FORM
NATIONAL & GLOBAL
FINANCIAL AID OFFICE
