Fill - Free fillable 2019-2020 Scholarship Reinstatement Request (Northern Arizona University) PDF form

scholarships@nau.edu | 855-628-6333

PO Box 4108, Flagstaff, AZ 86011

nau.edu/osfa

2019-2020

Scholarship Reinstatement Request

Deadline: Fall: November 15 Spring: April 15

Priority Dates: Fall: August 1 Spring: November 1

Note: Priority date will ensure you will receive a response by disbursement date.

 All requests must include a completed Reinstatement Request and supporting documentation.

 Complete reinstatement requests will be reviewed by the committee within 25 business days of receipt.

 Incomplete reinstatement requests will not be reviewed and/or may be denied.

 Students awaiting a decision are responsible for all tuition, fees, and other university charges by

assigned due dates. Late fees will not be waived for non-payment while awaiting a decision.

 Submission of this request does not guarantee approval of a scholarship reinstatement.

 You may only submit one reinstatement during your undergraduate career.

 The Reinstatement Committee reserves the right to award a merit scholarship of a lesser amount. No

appeals for a higher merit award will be allowed.

 You must be enrolled for the term you are trying to reinstate in order for you request to be reviewed.

B. Reason for Reinstatement Request

Check all reinstatement circumstances that apply and submit required supporting documents.

Circumstances Documentation

Major Life Event: You underwent a major life change that

negatively impacted your ability to meet your scholarship

requirements. Examples of this are a divorce or the birth of a

child.

 Separation agreement or divorce

decree

 Record of your child’s birth

 Any other documentation recording

the event

Mental or Physical Illness or Injury: You, or a member of

your family, suffered from a condition or incident that negatively

affected your ability to participate in your studies.

 Signed letter from physician,

therapist, or health professional

outlining illness or injury

 Police report

Death of a Family Member or Significant Person: A

member of your immediate family or an emotionally significant

person in your life passed away.

 Signed letter from a mental health

professional assisting you with grief

 Copy of a death certificate

Attended another institution: You attended another

institution for a full semester. (Must have attended NAU for a

minimum of 1 semester.)

 Official or unofficial transcript

showing grades earned

Work schedule: Your previous work schedule hindered your

ability to meet your scholarship requirements.

 Documentation from a supervisor

regarding workload adjustments

 Pay Stubs

Religious Mission: You completed a religious mission that

required you to be absent from school.

 Mission Certificate

A. Student Information

Term:

Student Name:

7-digit NAU ID Number:

Fall □

Phone:

NAU E-mail:

Spring □

scholarships@nau.edu | 855-628-6333

PO Box 4108, Flagstaff, AZ 86011

nau.edu/osfa

Submit this form and all additional documentation in-person to The Office of Scholarships and

Financial Aid on the 2

floor of Gammage (Building 1), upload at nau.edu/osfadoc-upload, or email to

scholarships@nau.edu.

C. Personal Statement (required)

Please attach a detailed explanation for the reason of your reinstatement request.

D. Agreement and Understanding

Please read and initial each item to verify that you understand and agree to the following:

I am including the appropriate documentation that supports my request and understand requests

submitted without supporting documentation may be denied.

I can submit only one scholarship reinstatement request for my undergraduate career.

Complete reinstatement requests will be reviewed within 25 business days.

Submitting this request does not guarantee reinstatement approval.

The decision notification will be sent to my NAU e-mail address.

If this request is approved, I must meet all renewal criteria specific to my scholarship in all future

terms to prevent future cancelation of my award.

I am responsible for paying all tuition, fees, and other university charges.

All decisions made by the Scholarship Reinstatement Review Committee are final.

I understand that the decision made by the Reinstatement Committee is final and I cannot appeal.

Student Certification: By signing below, I acknowledge that I have read and understand the information on

this form. I certify that all information on and submitted with my request is true and correct. I will provide

additional information if requested by the NAU Office of Scholarships and Financial Aid.

Typed, copied, or electronic signatures will not be accepted.

Student Signature:______________________________________ Date:_______________________

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