2019-2020
Graduate Student
Loan Modification or Cancellation 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
________________________________ _____________________ _____________________
Student Last Name Student First Name Goucher ID Number
□Request to MODIFY loan:
Please note that you will not be able to increase a loan unless you have previously accepted the loan at
below the maximum eligibility. If you are changing your loan amount to cover a specific balance or you desire a
specific amount to help with indirect costs, then please make sure you calculate in the origination fee.
* You may also indicate “Max” for us to calculate your maximum eligibility.
□ Request to CANCEL loan: Indicate which loans and for which terms you wish to cancel the loan.
By signing below, I understand that requesting a reduction or cancellation of the selected loan(s) may result in a balance owed to
Goucher College and that I am responsible to pay the balance due. I understand that certain financial aid programs require a
minimum enrollment to receive funding. I certify that I have taken origination fees into account when requesting a specific loan
amount. I certify all information reported on this form is complete & correct. I understand that additional tasks may be required if I
am requesting to increase a loan.
_____________________________________________ _____________________________
Student Signature Date
(ELECTRONIC SIGNATURES NOT ACCEPTED. Please print & sign in ink, then mail, fax, or scan and e-mail.)
