GUILFO
RD
TECHNICAL
COMMUNI
TY
COLLEGE
Financial Aid Office P.O. Box 309 Jamestown, NC 27282
Phone: 336.334.4822 Option 3 Fax: 336.217.8468
Post-Withdrawal Disbursement Form
Student Name: _______________________________________________________
GTCC ID: _______________________________________________________
Permanent Phone Number: _______________________________________________________
Personal Email: _______________________________________________________
Address (Street, City, Zip): ______________________________________________________
For Which Term is This Post-Withdrawal Disbursement
☐ Fall ☐ Spring ☐ Summer
Select One of the Following:
☐ I accept the full loan amount being offered as a post-withdrawal disbursement.
☐ I accept a portion of the loan amount being offered as a post-withdrawal disbursement.
AMOUNT REQUESTED: $ _____________________
This form must be submitted within 14 days of the date of the notification letter you received. If you
accept the aid offered, it will be applied to any debt owed to the college and a refund for the balance sent
to you. If written notice is not received within the 14 day period, we will cancel the funds with the
Department of Education.
Student Signature Date
Please return this completed form to: GTCC Financial Aid Office, PO Box 309, Jamestown, NC 27282
or FAX to 336-217-8468.
click to sign
signature
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