O
FFICE OF STUDENT FINANCIAL AID
R
EQUEST FOR CHILDCARE EXPENSES 2020-2021
Print Name: Banner: XXX ______
Last 6 Digits Only
(DISTANCE LEARNING STUDENTS ARE NOT ELIGIBLE FOR CHILDCARE EXPENSES)
CHILDCARE EXPENSES may be added to a student’s cost of education provided no other agency,
program, or person is paying or is expected to pay these expenses. The maximum allowance for childcare
is $3000.00 per child for the academic year. Please provide the following documentation with your
request:
• A recent copy of the daycare invoice; and/or
• Provide copies of canceled checks made payable to the childcare provider or receipts of
payment.
Please indicate the semester you are requesting the adjustment: FALL SPRING SUMMER
Name of childcare provider:
Address of childcare provider:
Telephone number of childcare provider:
Name(s) and age(s) of child requiring childcare: (A copy of each child’s birth certificate may be required.)
Please read and initial each of the following and return this form to the Office of Student Financial Aid.
I understand that any additional funds awarded may be Subsidized, Unsubsidized, Parent PLUS, Graduate
PLUS and/or Alternative loans.
I understand that the additional funds awarded will be disbursed twice in the academic year; one half in
the fall semester and the remaining half in the spring semester.
The amount I am requesting is $ ________________
. (Maximum amount $3,000.00)
I understand that due to Loan and Cost of Attendance limits, the Office of Student Financial
Aid may not be able to provide the full amount requested.
SIGNATURE DATE
PLEASE RETURN TO
N
ORTH CAROLINA AGRICULTURAL AND TECHNICAL STATE UNIVERSITY
O
FFICE OF STUDENT FINANCIAL AID
1601
EAST MARKET STREET
G
REENSBORO, NC 27411
336-334-7973
TELEPHONE 336-334-7954 FAX
Revised 11/19
