Office of Financial Aid
3900 University Blvd., Tyler, Texas 75799
www.uttyler.edu/financialaid/
Phone (903) 566-7180
Fax (903) 566-7183
Cost of Attendance Adjustment
Student Name: ____________________________________________ Student ID:_________________________
(Last, First, MI)
Indicate the semester for which you are requesting a Cost of Attendance adjustment and the nature of your request. Any
expenses for which you are requesting an increase must be incurred during the current academic year. If necessary provide
documentation at the time you submit the request.
I am requesting a Cost of Attendance Adjustment for:
Fall _____________ Spring __________ Summer ________
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Disabled student expenses. Required documentation: List of items required for student to attend and complete
successfully in their classes and are unreimbursed by other agencies. Must include receipts of expenses. Expenses must
be for the current academic year.
□
Professional License or Certificate. Required documentation: Letter from department indicating the purchase of the
license or certificate is required by a state or required to practice or be employed in their profession and receipts of
expenses for the purchase of the license or certificate. Expenses must be for the current academic year.
□
Unreimbursed dental or medical expenses. Required documentation: Receipts of incurred expenses or proof deposit paid
not covered by insurance. Student only. Expenses must be for the current academic year. Cost of Attendance increase
cannot exceed $4500.
□
Dependent childcare Expenses. Required documentation: Most recent monthly receipt showing paid expenses not
covered by third party. Cost of Attendance increase cannot exceed $4500.
□
Purchase of instrument or other item(s) for academic purposes. Required documentation: Letter from department or
professor indicating the purchase of the instrument or other item(s) is required for student to be successful in academic
program and receipts of expenses for the purchase of instrument or item(s). Expenses must be for the current academic
year. Cost of Attendance increase cannot exceed $4500.
□
Purchase of a computer required by department. Required documentation: Letter from department or professor
indicating the purchase of the computer is required for student to be successful in academic program and receipts of
expenses for the purchase of the computer. Expenses must be for current academic year. Cost of Attendance increase
cannot exceed $3000.
□
Purchase of a computer (One time option). Required documentation: None. One-time consideration during the student’s
college career for the purchase of a computer. Cost of Attendance increase cannot exceed $1000.
I certify that all the information provided on this form and in any supporting documentation is complete and correct. I must sign
and return this form for my request to be processed. Electronic signatures are will not be accepted.
Signature:______________________________________________ Date: _____________
