Financial Aid
937.328.6034 | financialaid@clarkstate.edu | 570 East Leel Lane, Springfield, Ohio 45505
Financial Aid Award Request Form
The purpose of this form is to request an adjustment to an existing federal Pell grant, federal Subsidized and/or
Unsubsidized loan. Please submit the completed form to the Financial Aid Oce. Reinstatement/request for an
increase of federal student loans are subject to Cost of Attendance limits.
SECTION A: Student Information
Name: _________________________________________________ Student ID Number: ______________________
Primary Phone: _____________________________
SECTION B: Request to adjust federal Pell Grant
Cancel my Pell Grant for: Fall 2020 Spring 2021
SECTION C: Request to adjust federal student loan amount
If multiple terms are selected, disbursements will be equally split. If one term is selected it wil be split into two disbursements.
Please indicate the semester(s) for the adjustment: Fall 2020 Spring 2021
Cancel my: ____ Unsubsidized Loan ____ Subsidized Loan
Request Reinstament for a loan(s) I rejected:
____ Unsubsidized Loan ____ Subsidized Loan ____ Both Subsidized and Unsubsidized
Reduce my: ____ Unsubsidized Loan by: $__________ ____ Subsidized Loan by $__________
Request an additional loan for: $_____________
Please note, students cannot exceed the following annual loan limits.
Annual Loan Limit Dependent Students Independent Students
First-Year
(1–29 completed program
credit hours)
$5,500 — No more than $3,500 of this
amount may be in subsidized loans.
$9,500 — No more than $3,500 of this
amount may be in subsidized loans.
Second-Year
(30+ completed program
credit hours)
$6,500 — No more than $4,500 of this
amount may be in subsidized loans.
$10,500 — No more than $4,500 of this
amount may be in subsidized loans.
SECTION D: Certification Statement
I certify that all of the information on this form and accompanying documents are true and complete to the best
of my knowledge. Furthermore, I arm that I have not knowingly or intentionally provided any false or fraudulent
documentation.
Student Signature: ____________________________________________________ Date: ____________________
FOR OFFICE USE ONLY
COA $_____________ Estimated Aid $____________ Request completed? Ye s No
If no, why?__________________________________________________________________________________
Signature of authorized school ocial: ________________________________________ Date: _____________
Financial Aid
FAC20FAR
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