Lost Eligibility Worksheet and Waiver Request Form
Waivers that are turned in less than two weeks before the upcoming semester start date will not be processed in time to be used as a deferral towards tuition and fees. You will be responsible for payment after this date. Once you have completed all necessary information, you will need to schedule an appointment with Student Engagement before returning the form to the CCC Financial Aid Office. If you are unable to meet with them in person, please call to schedule a phone conference with their office. Additional information may be requested. Please follow the instructions below.
– Fill out page two – Lost Eligibility Worksheet by completing your name, your
Social Security # and your MyCayuga ID #. Choose the appropriate explanation. If none of these reasons applies to your situation, a waiver probably WILL NOT be granted. Keep in mind that some options require documentation or an explanation of the circumstances. Waivers requiring documentation are only granted for circumstances beyond the student's control. Please note: leaving school or dropping classes in order to work is not grounds for a waiver. You cannot use the same reason for more than one waiver except for reason #5.
– Fill out page three – Waiver Request Form by completing name, Social Security # and your MyCayuga ID #, address, whether it is for State or Federal Aid and sign the waiver.
– Fill out page four – Authorization for Release of Health Records only if there was a medical reason. Give this page to your medical provider to complete and return to our office.
– After you have completed pages two and three (and page four if applicable) make an appointment with a Student Engagement Counselor to review and sign your Waiver Request Form. Waivers will not be processed without a signature from their office.
– If Student Engagement signs your Waiver Request Form, return all pages to the Financial Aid Office for approval. You will be able to check the status of your waiver by logging in to your MyCayuga account. A waiver may be granted only once for any particular situation.
Please Note: If none of the reasons on page two applies to your situation,
a waiver probably WILL NOT be granted.
For more complete information on maintaining aid eligibility please consult the
CCC website at: www.cayuga-cc.edu.
Lost Eligibility Worksheet
To be returned to Financial Aid
MyCayuga ID# ___________________________________________________
– Check the appropriate explanation. If none of these reasons applies to your situation, a waiver probably WILL NOT be granted. Please note: You cannot use the same reason for more than one waiver except
for reason #5.
– NOTE: Leaving school or dropping classes in order to work is not grounds for a waiver.
– Waivers requiring documentation are only granted for circumstances beyond the student's control.
– A waiver may be granted only once for any particular situation.
– If your academic record indicates that you will be unable to complete your degree by the time you have attempted 90 credits, you will generally not be eligible for a waiver.
– If you have questions on completing this form, contact the Financial Aid Office at (315) 255-1743 ext. 2470.
– Many factors must be considered when evaluating a waiver request. NOT ALL WAIVER REQUESTS WILL BE APPROVED!
Federal and/or State Aid
last year due to my illness, accident or a death in the family.
REQUIRES DOCUMENTATION: For illness or accident, have your physician complete the
enclosed confirmation form. Do not submit actual medical records. For a death in the family,
attach a death certificate or copy of the obituary along with an explanation of your relationship
to the deceased. Waivers for extenuating circumstances will not be granted for consecutive
2. ____ I was a student at CCC over a year ago with a poor academic record and now realize the
importance of a college education.
NOTE: Two (2) full semesters must have passed since you lost eligibility and since you last
received financial aid. If you have taken any courses since you lost eligibility, you must pass
all courses attempted with a 2.0 GPA for that semester, no withdrawals, no F's and no
incomplete grades. Write a letter explaining the circumstances of your withdrawal from
CCC and what has changed to make you believe you can now be successful.
Federal Aid ONLY
3. ____ Other extenuating circumstances beyond the student's control.
REQUIRES OFFICIAL DOCUMENTATION from a source other than the student.
The documentation must prove that (1) the situation occurred and (2) that it is unlikely to recur.
Waivers for extenuating circumstances will not be granted for consecutive semesters.
4. ____ I am in a second degree program that has been approved by the Centers for Student Engagement and Academic Advisement.
(Note: Current degree evaluation must be attached). Generally there is a 2 semester maximum for
completing a second degree.
5. ____ I previously attended CCC without successfully completing the required number of credits.
However, I have just completed a semester of 6 credits or more with a 2.0 GPA for that semester,
no withdrawals, no F's and no incomplete grades. (Attach grade report from prior semester).
Waiver Request Form
New York State and Federal Student Financial Aid
Before completing the Waiver Request Form, a student should read and complete the Lost Eligibility Worksheet.
1. To be completed by student:
MyCayuga ID# ____________________________________________
Address ______________________________________ Phone # ____________________________
City _____________________________ State ___________ Zip code ______________________
I request a waiver for: ________ State Aid ________ Federal Aid
I understand that a waiver may be granted only once for New York State awards and only twice for Federal awards. I also recognize that at the end of the semester for which the waiver is granted:
– I must fulfill the minimum standards required for continued receipt of financial aid or
– I may apply for an extension of my waiver if I was registered for 6 or more credits and completed all credits, (no F's, or W's), with a 2.0 GPA or higher.
Student Signature _______________________________________________ Date ______________
2. To Be Completed by Student Engagement Counselor
I have reviewed this waiver request. Based upon the documentation provided (if required) and my evaluation of this student's potential for academic success, I recommend:
Approval _______ Disapproval _______ of this request.
Counselor Signature _____________________________________________ Date ______________
3. To be Completed by the Financial Aid Committee
Based on the documentation provided and the counselor recommendation, this request is:
Federal: Approved _____ Denied _____ State: Approved _____ Denied _____
Comments and conditions ______________________________________________________________
Authorization for Release of Health Records
(To be completed by student)
Student Name ______________________________________________________________________________
MyCayuga ID# _______________________________________________________
Student Signature _________________________________________________ Date ___________________
This form should NOT be used for chronic illnesses or for conditions which
were present prior to the semester for which you are seeking a waiver.
Confirmation of illness/accident
(To be completed by your physician)
I certify that ___________________________________________________________ was treated by me
from (date) _____________________________ to ______________________________ due to illness,
accident or complications of pregnancy. (NOTE: normal pregnancy should not be included.)
Please check both if they apply:
_______ During this period of time the student was unable to attend classes.
_______ The student is now able to return to classes.
Additional Comments _____________________________________________________________________________________
Physician signature _______________________________________________________
Physician printed name ____________________________________________________
Physician phone number ___________________________________________________