EWC’s Hathaway Scholarship
Reinstatement Request
A student who previously lost eligibility for a Hathaway Scholarship or who requested a deferment of his/her Hathaway award must
complete this form to have the scholarship reinstated and to reaffirm eligibility criteria. Students must complete this request
PRIOR to the beginning of the semester for which reinstatement is requested.
Students must clearly indicate the semester for which reinstatement is requested and detail the reason for the request. ALL
ELIGIBILITY QUESTIONS MUST BE ANSWERED or the Reinstatement Request will remain inactive.
___________________________________________________________________ _______________ _______________
Last Name First Name M.I. EWC Student ID WISER ID:
_______________________________________________________________________________ _____________________
Student Mailing Address, City, State, Zip Date of Birth (mm/dd/yy)
____________________________________________________________________ ________________________________
E-Mail Address Phone number (include area code)
• I am requesting reinstatement of my Hathaway award for the following semester:
Fall ______ Spring ______ Summer ______
• I am r
equesting reinstatement of my Hathaway award because (please indicate reason for reinstatement request):
____ I lost eligibility for my Hathaway during a previous semester
____
I requested deferment of my Hathaway during a previous semester
Please indicate
deferment term(s): Fall _____
Spring _____ Summer _____
• Pl
ease answer each of the following by checking Yes or No:
___ Yes ___
No Are you a U.S. Citizen?
___ Yes ___ No ___ N/A If male, have you completed Selective Service Registration? If female, check N/A.
___ Yes ___
No Are you in default on a federal Title IV education loan?
___ Yes ___
No Are you in overpayment (owe a refund) on a federal Title IV grant?
___ Yes ___
No Have you been convicted of a felony in Wyoming or another jurisdiction?
___ Yes ___
No Are you incarcerated?
By signing and submitting this form, I certify that all of the information reported is complete and correct. I understand that I have
requested to have my Hathaway Scholarship reinstated beginning with the semester indicated above. I understand that all Hathaway
standards must be met to for my Hathaway Scholarship to be reinstated and for me to continue receiving the award. It is my
responsibility to contact the financial aid office at the college/university that I am attending with questions or for more information
regarding the Hathaway Scholarship Program.
Hathaway Scholarship eligibility shall not extend beyond the equivalent of eight full-time semesters, or extend to any semesters that
commence six academic years after initial eligibility. A maximum of four full-time semesters can be received at a Wyoming
community college. Provisional Opportunity Hathaway Scholarships can only be used at a Wyoming community college.
Student signature: ________________________________________________________ Date: __________________________
10/2017
REINSTATEMENT AND ELIGIBILITY INFORMATION
CERTIFICATION AND SIGNATURE
RETURN COMPLETED FORM TO:
EWC Financial Aid Office
3200 West C Street
Torrington, WY 82240
p: 307.532.8327 f: 307.532.8222
financialaid@ewc.wy.edu
EWC Reinstatement Request
