2021-2022 Authorization to Decline Pell Grant Form
Student Name:
________________________ GCU Student Number: ________________
I, ________________________ (name of student), would like to decline the Pell Grant funds
for which I am eligible to receive. I understand that these funds may not be available once
the 2021-2022 award year is over. I understand that the maximum eligibility for
the 2021-2022 Award Year is 150% of the Pell Grant amount.
Student Signat
ure: ________________________ Date: ________________
HANDWRITTEN SIGNATURES REQUIRED TYPED/ELECTRONIC SIGNATURES NOT ACCEPTED
P0109082020