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
Send this form and supporting documentation to Ms. Polly Burns, Oce of Financial Aid, Jere Whitson 302
or P. O. Box 5076.
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:
TTU 085-0155-01/An EEO/AA/Title IX/Section 504/ADA/University/A Constituent University of the Tennessee Board of Regents
