Tennessee Tech University
Scholarship Request for Exception
Name: ________________________________________ T number: _____________________
Email: ________________________________________
Phone: _______________________________________
Indicate the Semester for which you are seeking an exception: __________________________
Indicate the scholarship requirement for which you are seeking an exception:
___ Maintain full-time status
___ Maintain good academic standing
___ Complete service hours (if required for your scholarship)
___ Maintain cumulative GPA required
___ Maintain continuous enrollment each fall and spring semester
Apply for scholarships/Accept a scholarship by the deadline given
Indicate the reason for your request: (Very few exceptions not fitting one of these categories will be approved)
___ Major illness of student
___ Major illness or death of an immediate family member (parent, sibling, spouse, child
___ Extreme financial hardship (student must have completed FAFSA on file for this to be considered)
___ Extraordinary circumstances beyond the student’s control where meeting the renewal requirements
creates a substantial hardship
Please explain in detail why you wish for the scholarship committee to make an exception on your behalf.
Attach additional pages if more space is needed.
Attach any verifiable documentation that you may have (lawyer, scholarship offer, etc). To protect your
privacy, all medical records/documentation must be submitted to the Accessible Education Center at RUC
112 or 1000 N. Dixie, Campus Box 5091, Cookeville, TN 38505.
Submit this form to the Scholarship Office, 1000 N. Dixie, Campus Box 5166, Cookeville, TN 38505 or
I understand that if my exception is approved, I will be required to meet all requirements for the remaining
semesters on my scholarship.
Student Signature_____________________________________
Date: ______________________
Approve___ Deny____ Date____________ Emailed? _______
Scholarship Office Use Only
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