Yuba Community College District
Financial Aid Offices
Decline Financial Aid Awards for 2020-2021
_____________________________________________________ _______________________________
Last Name First Student ID
_______________________________
Phone Number (Include area code)
____________________________________________________
_
Mailing
____________________________________________________
_
City State Zip Code
STUDENT: Complete this section.
1. I am requesting to decline financial aid for the following semester(s):
Fall 2020 Spring 2021 Summer 2021
2. I am declining the following grants/awards:
Pell Grant Federal Work-Study FSEOG CALB/C CCCG FTSSG EOPS CARE
Scholarship(s) Other: _________________________________________________________
3. I am requesting to cancel my financial aid award(s) for the following reason(s):
__________________________________________________________________________________________
__________________________________________________________________________________________
Note: If you have already received financial aid funds for a term selected above, you must repay all financial aid
funds before this request can be processed.
Certification: I have read and understand the information stated on this form. I certify that the information provided on this form is
true and correct to the best of my knowledge. I understand that this information will be used to determine my eligibility and that false
or misleading information may be cause for denial, termination, and/or repayment of financial aid funds.
_________________________________________________ _______________________________
Student Signature Date
FINANCIAL AID OFFICE USE ONLY
Awarded(s) Adjusted/Amended: Pell FWS FSEOG CAL B/C CCCG FTSSG EOPS CARE
Scholarship(s) Other: __________________________________________________________________________
Term: Fall 2020 Spring 2021 Summer 2021
Comments: _________________________________________________________________________________________
___________________________________________________________________________________________________
______________________________________ ___________
Financial Aid Signature Date
03/23/20
Yuba College
2088 North Beale Road
Marysville, CA 95901
530-749-7999
Woodland Community College
2300 East Gibson Road
Woodland, CA 95776
530-661-5725
Lake County
Campus
15880 Dam Road Extension
Clearlake, CA 95422
707-995-7923
click to sign
signature
click to edit
click to sign
signature
click to edit