Tennessee Technological University
Tennessee Education Lottery Scholarship (TEL) Recipients Request
permission to continue on TEL during the _____ semester, 20 ___
_____ aer dropping below full time or half time, or
_____ Total withdrawal from the university
Drop off this form and supporting documentation to the Lottery Specialist, Office of Financial Aid, Jere
Whitson 301 or mail to Office of Financial Aid, 1000 N. Dixie Ave, Box 5076, Cookeville, TN 38505
Name ______________________________________ Student ID _______________________________
Address ____________________________________ Phone ___________________________________
____________________________________ Email ___________________________________
Indicate the basis for your request below and attach veriable documentation. Forms will not be acccepted
without copies of proper documentation (hospital, doctor, lawyer, etc.).
_____ Major illness of student
_____ Major illness or death of an immediate family member (parent, sibling, spouse, child)
_____ Extreme nancial hardship
_____ Extraordinary circumstances beyond the student’s control where continued enrollment status by
the student creates a substantial hardship
Briey describe your reason below: Use the back of this sheet if additional space is needed
Student’s Signature __________________________________ Date: __________________________________
Oce use only:
Administrative Action: Denied _____ Approved _____ Date: __________________________________
Comments:
