University of Central Missouri
Office of Student Financial Services
P.O. Box 800
Warrensburg, MO 64093-5178
Phone 660-543-8266
FAX 660-543-8080
Webpage:
www.ucmo.edu/sfs
Request to Receive
Financial Aid to Attend a
School Other than UCM
(Consortium Agreement)
UCM use only
A
ttend_Another_School_18.pdf Page 1 of 2
NOV 3, 2017
CONS1
To: Academic Advisor, Faculty Advisor, or Internship Director
From: ________________________________________ 700_______________________________
Student's Name (please print) UCM ID Number
I wish to receive financial aid to help pay the educational and living expenses I will incur to enroll for
one or more classes at a college, university, or educational institution other than UCM. I am
submitting this request because unique or special circumstances exist that prevent me from enrolling
(or make it very difficult for me to enroll) for the following class(es) at UCM.
College, university, or school I plan to attend: _____________________________________________
City and State: ______________________________________________________________________
Course Number, Title, and Description of class(es) to be completed (be specific):
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
If any coursework will be completed on-line, please explain: ________________________________
__________________________________________________________________________________
Beginning Date: _________________________ Ending Date: ______________________ of classes
My address (if known) during the above period will be: _____________________________________
__________________________________________________________________________________
Following are the total estimated expenses I’ll incur at the above school during the above period:
Tuition and Fees ...................................................................... $ ________________
Application and other required program fees .......................... $ ________________
Room (Housing) ...................................................................... $ ________________
Board (Meals) ........................................................................... $ ________________
Books and Supplies................................................................... $ ________________
Transportation .......................................................................... $ ________________
Personal Expenses and Supplies .............................................. $ ________________
Other ........................................................................................ $ ________________
TOTAL .......................................................................... $ ________________
Please proceed to Page 2 …
0
Page 2 Request To Attend Another School Student’s Last Name ___________________ UCM # 700____________
Student Statement (Required)
Following is the primary reason (please be specific!) I must attend one or more classes at a college,
university, or educational institution other than UCM. In accordance with federal financial aid
regulations, I understand that the UCM Office of Student Financial Services may or may not be
able to approve my request.
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
(continue on a separate page, if necessary.)
_________________________________________________________ _______________________________
Student’s Signature Date
========================================================================
Before submitting this document to the Office of Student Financial Services,
you must obtain the following approval.
I approve of this student's plan to attend a college, university, or educational institution other than
UCM. (S)he intends to complete and earn ______ credit hours, all of which will apply toward
completion of his/her UCM degree requirements. I believe this student’s intended coursework at
another school represents a necessary, valuable, and/or complementary component of the academic
program (s)he is pursuing at UCM.
Comments/Clarification:______________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
_____________________________________________________________ __________________
Signature of UCM Academic Advisor or Faculty Advisor Date
Complete and submit this document to the UCM Office of Student Financial Services in person (1100 Ward Edwards
Bldg.) or by mail (Student Financial Services, P.O. Box 800, Warrensburg MO 64093-5178), or by fax (660-543-8080).
Attend_Another_School_18.pdf NOV 3, 201 Page 2 of 2
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