Northwest State Community College • 22600 State Route 34 • Archbold • OH • 43502
Phone: 419-267-1333 • Fax 419-267-5587 • finaid@northweststate.edu
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Student’s Name NSCC ID number
According to the Common Origination and Disbursement Web Site (COD), it appears that you have Federal Financial Aid at
another educational institution. In order to have aid processed at Northwest State, you will need this form completed by a
Financial Aid Administrator at your previous educational institution in order to comply with federal regulations. Please fill in
the information indicated above, sign and date below for release of information authorization, and forward to your previous
educational institution with instructions to complete and return to Northwest State to the address listed at the bottom of this
page.
No further action can be taken on your application for federal student aid with Northwest State
until your prior educational institution has returned this form to our office and cancelled all pending aid in COD.
2020-2021 Multiple
Reporting Clearance
__________________________________________ __________________________
Student’s Signature Date
Northwest State Community College does not discriminate on the basis of race, color, national origin, sex, gender identity, disability, religion or age in its programs
or activities.
School Certifying Official
The student listed above is currently applying for financial aid at Northwest State Community College. According to COD,
this student has aid awarded at your institution. Please cancel all pending aid in COD and sign below to certify that all aid
awarded for the above named student has been cancelled at your institution and that all agencies or processors have
been notified of the cancellation.
____________________________________________________ ____________________________
Institution Name Telephone
______________________________________________________________________________________________
Address City State Zip
Please cancel all awards in COD and list below all financial aid that was disbursed to the student for each semester(s)
Summer 2020
2020
___________________________________________
Spring 2021 Pell $________
_____________________________________________
Student’s Expected Last Date of Attendance
Loan Period
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Name of Certifying Official Title
______________________________________________ ___________________________________________
Email Address Phone Number
______________________________________________ ___________________________________________
Signature of Certifying Official Date
