Fillable 2016/2017 FINANCIAL AID APPLICATION (Bastyr University)

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2016/2017 FINANCIAL AID APPLICATION (Bastyr University)

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2016/2017
FINANCIAL AID APPLICATION
FINANCIAL AID APPLICATION PRIORITY DEADLINE: April 15, 2016
**In addition to this application, you will need to complete a 2016/2017 FAFSA at www.fafsa.gov**
If you are in need of a PLUS loan, you must also complete a separate PLUS loan application.
Students new to Bastyr will need to print this form and wet sign. The completed application can be sent to the
Financial Aid Office via:
Mail: E-mail attachment: Fax:
Office of Financial Aid finaid@bastyr.edu (425) 602-3094
14500 Juanita Dr. NE
Kenmore, WA 98028
Continuing Bastyr students may e-mail the completed application to finaid@bastyr.edu. The form must be SENT
FROM YOUR BASTYR.EDU E-MAIL to be considered electronically signed.
NOTE: Incomplete applications and missing documentation could delay processing of your financial aid. When completing this
form, use black or dark ink only and answer all questions.
DEMOGRAPHICS
Continuing Bastyr student New student to Bastyr
First Name ____________________________ Last Name _____________________________________ Middle Initial ______
Social Security Number __________- __________ - _______________
List all names used previously
Date of Birth ______ / ______ / ____________ Gender: Female Male
Marital Status: Married Single Other ________________ U.S Citizen or permanent resident: Yes No
Driver’s License Number ___________________________________________________ State __________
E-mail address:
Mailing Address Permanent address (if different)
Telephone: (day) ( ) Telephone: (day) ( )
(eve) ( ) (eve) ( )
PROGRAM AND BUDGETING INFORMATION CAMPUS: Kenmore San Diego
Level of degree: ND/Professional Graduate Undergraduate Certificate Post Baccalaureate
Do you plan to take prerequisite courses at Bastyr in summer 2016? Yes No
Estimated date of graduation:
Program: __________________________ Mo/Yr ___________ Second Program: _________________________ Mo/Yr ___________
DO NOT INCLUDE AUDITED COURSEWORK IN THIS SECTION. Enter the estimated number of credits in which you will be enrolled
in for the 2016/2017 school year, as accurately as possible. Include only terms you are seeking financial aid. Please enter zero if not attending
any given term.
_______Summer 16 _______Fall 16 _______Winter 17 _______Spring 17 _______Summer 17
I am applying for (check all that apply): Grants Loans Work Study
**Please notify the Financial Aid Office if you will be receiving an outside scholarship, free tuition as faculty/staff, or a private student loan during the
2016/2017 academic year.
Electronic communication disclosure:
Bastyr University uses electronic means (e-mail and website) to provide required notifications to you. We feel this is the fastest and
greenest way to communicate. We encourage you to consent to this form of communication. If, however, you would prefer to receive
all notices printed out and put in your student mailbox, you may opt out of electronic communication by notifying the Director of
Financial Aid, Danette Wells, in person, in writing, via e-mail or by phone. You may do this at any time during your attendance at
Bastyr, even if you have previously authorized electronic communications.
The types of notices that we provide electronically include (but are not limited to):
Application process reminders
Financial Aid Office policies
Award letters
Disbursement notices
Scholarship opportunities
Satisfactory Academic Progress notices
Loan counseling information
Work study information
CERTIFICATIONS – Please sign and date the completed certifications. Your application will not be processed
without your signature in this section. (If you are completing this electronically and emailing it to our office, you
must either scan your original signature, or fax this page with signature)
All of the information provided by me or any other person on this form is true and complete to the best of my knowledge. If
asked by an authorized official, I agree to provide proof of the information that I have given on this form. I realize that this
proof may include a copy of my U.S., foreign, state, and/or local income tax return. I also realize that if I do not give proof
when asked, I may be denied aid. I certify that I, the student, do not owe a refund on any federal student grant and am not in
default on any federal student loan. I also have not borrowed in excess of the federal student loan limits, under the federal
student aid programs, at any institution, or any combination of institutions. I will use all financial aid funds received only
for expenses related to my study at Bastyr University. I consent to receive all financial aid notices via electronic means. If
I want to opt out of electronic communications, I will contact the Director of Financial Aid. Warning: To receive any Title
IV financial aid, you must sign below. If you purposely provide false or misleading information on the FAFSA or on this
application, you may be fined $20,000, sent to prison, or both.
____________________________________________ _______________________
Signature Date
**no handwritten signature is needed from CONTINUING Bastyr students if this form is submitted through e-mail from a
bastyr.edu e-mail account. This form may be attached to an e-mail and sent to finaid@bastyr.edu.
“Bastyr University is an equal opportunity institution. We do not discriminate in matters of employment or participation in programs, services or benefits
on the basis of gender, race, creed, color, religion, national origin, age, sexual orientation, gender identification, individuals with disabilities, or veteran
status. Our programs, services and facilities are accessible to individuals with disabilities. Please contact the university in advance if you require special
accommodation due to a disability.
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20162017 FINANCIAL AID APPLICATION (Bastyr University)

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Completed 17 August 2020

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