California State University, Sacramento
Financial Aid & Scholarships Office
6000 J Street • Sacramento, CA 95819-6044
T (916) 278-1000 • F (916) 278-6082
FINANCIAL AID AWARD & ENROLLMENT FORM
Complete and submit this form to verify your financial aid award, cost of attendance and enrollment status to your designated
third party. Completed form can be submitted by any of the following:
• Use your CSUS email account and send to sacstatessc@csus.edu with “Financial Aid Verification” in the subject line
• Mail form to the address listed at the top of the form
Once received, allow 5-7 business days for your request to be processed.
NOTE: One copy is filed in the student’s school record and one copy is sent to the person/agency. The form is NOT returned to the student.
Third Party Release
This section is completed by the student
Person/Agency Name: ______________________________________Address________________________________________________
Phone Number: _________________Fax Number: ________________Email Address:__________________________________________
I hereby authorize the Financial Aid & Scholarship Office at Sacramento State University to release my financial aid status and any other
relevant information to the following person(s) or Agency.
Student Signature: ____________________________________ Date:_____________________
Financial Aid Verification
This section is completed by the Financial Aid & Scholarship office
___This student has not applied for financial aid for the school year: _________________
___This student financial aid file was closed on ______________ for___________________________
___This student is not receiving aid for the following semester(s): ___Fall _________ ___Spring _________ ___Summer _________
___This student is receiving/scheduled to receive aid for the following period(s):
___Fall 2020 to Spring 2021: (8/21/20-5/14/21) ___Spring 2021: (1/25/21-5/14/21)
___Fall 2020: (8/21/20-12/11/20) ___Summer 2021: (5/24/21-8/20/21)
Grants
Offer
Paid Period
Loans/Other
Offer
Paid Period
Federal Pell Grant
Federal Perkins Loan
Federal SEOG Grant
Direct Subsidized Loan
Educational Opp. Grant
Direct Unsubsidized Loan
State Univ. Grant
Parent/Grad PLUS Loan
Cal Grant A / B / SWD
Other:
Total
Total
Cost of Attendance (Student Budget)
All financial aid awarded at Sacramento State is intended to meet the educational costs associated to the student.
Details on our Award Notification Guide.
Program Status: ___Undergraduate ___Graduate ___Doctorate ___Teaching Credential
Enrollment Status: Fall 2020 _________ Spring 2021 _________ Summer 2021 _________
Expected Date of Graduation: __________________
Costs
With Parent
On-Campus
Off-Campus
Other
Books/Supplies
*Fees
Food/Housing
Loan Fees
Misc./Personal
Non-Resident Tuition
Transportation
Total
*Graduate students add $1506 for graduate registration fees; Teaching Credential students add $1398. State-supported MBA students add $270 per unit for graduate business professional
fee. Non-resident students add $396 per unit for non-resident registration fees. The CSU makes every effort to keep student costs to a minimum. Fees listed in published schedules or
student accounts may need to be increased when public funding is inadequate. Therefore, the CSU must reserve the right, even after initial fee payments are made, to increase or modify any
listed fees, without notice, until the date when instruction for a particular semester or quarter has begun. All CSU listed fees should be regarded as estimates that are subject to change upon
approval by the Board of Trustees.
Request completed by _________________________ Staff Signature_____________________________________ Date _______________
R:10/29/20 FILE 20/21
Student Name: _______________________
Sac State ID#: _______________________
(sending from your CSUS email is acceptable in lieu of signature)
$ 0.00
$ 0.00
$ 0.00
$ 0.00
$ 0.00
$ 0.00
$ 0.00
$ 0.00
$ 0.00
$ 0.00
$ 0.00
$ 0.00
$ 0
(staff name)
Full-time
Full-time
Not Enrolled
$ 1,096.00
$ 7,418.00
$ 6,816.00
$ 50.00
$ 2,564.00
$ 1,610.00
$ 19,554
$ 1,096.00
$ 7,418.00
$ 16,134.00
$ 50.00
$ 2,564.00
$ 1,610.00
$ 28,872
$ 1,096.00
$ 7,418.00
$ 16,580.00
$ 50.00
$ 2,564.00
$ 1,610.00
$ 29,318
08/2020-05/2020
click to sign
signature
click to edit