Fill - Free fillable 18 19 Merit Reinstatement PDF form

2018-2019 Merit Scholarship

Reinstatement Request

Office of Student Financial Aid

1021 Dulaney Valley Road

Baltimore, Maryland 21204-2794

P: 410-337-6141

F: 410-337-6504

E: finaid@goucher.edu

INSTRUCTIONS: Complete the information below and submit this form along with documentation to the

financial aid office. Requests are usually by committee, so please allow at least 3 weeks for a response.

1. STEP ONE: Tell us about yourself.

____________________________ _____________________ __________________

Student Last Name Student First Name Goucher ID Number

____________________________ _____________________ _______________________

E-mail Daytime Phone Number Evening Phone Number

2. STEP TWO: Tell us why you failed to meet the GPA requirement for your merit scholarship.

☐ Death of a relative. Please provide name and relationship to you:

____________________________________________________________________

☐ Injury or illness of student or relative.

☐ Other special circumstance beyond the student’s control.

Please explain briefly (If additional space is needed please attach a separate written explanation):

3. STEP THREE: Tell us what has changed in your situation that will allow you to complete the next

semester successfully.

Please explain briefly (If additional space is needed please attach a separate written explanation):

4. STEP FOUR: If possible, provide supporting documentation for the information you stated in Steps 2

and 3. Please submit this form with all supporting documentation as a single package.

5. STEP FIVE: Sign and date the following statements of understanding:

• The student will be notified via email of the appeal decision.

• If the request is denied a student may regain eligibility if they meet the GPA requirement in future

semesters.

By signing this form, I certify that I understand all of the above and that all information reported on this form & within the enclosed

documentation is complete & correct.

_____________________________________________ _____________________________

Student Signature Date

(ELECTRONIC SIGNATURES NOT ACCEPTED. Please print, sign in ink, then mail, fax, or scan and e-mail.)

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