Fax Memo

							                                                         ADMISSIONS OFFICE


                           Concord University Request for Reinstatement of Institutional Scholarship(s)


Current Concord University students interested in requesting reinstatement of institutional scholarship(s) must complete all the
following steps and return all necessary documentation to the Admissions Office.

1.         Complete this form.

2.         Provide written documentation for the reason(s) for requesting reinstatement and include information on why your
           institutional scholarship(s) should be reinstated.

3.         A committee of three members of the Concord University administration, faculty and/or staff will review the request for
           reinstatement. The committee will be chaired by the Director of Enrollment who will not be part of the review. The
           committee will recommend a decision to the Director who will inform the student. The decision of the committee can be
           appealed to the Vice President of Student Affairs.


Please complete the following information:

Name:                                                                           SSN:

Address:

City:                                                                State:                                Zip Code:

Contact Phone:

Have you filed the most current Free Application for Federal Student Aid (FAFSA)?                                   Yes           No
(If No, the FAFSA must be completed and processed by the Financial Aid office before this application can be reviewed.)
Have you accepted all loans including the Stafford, Perkins, etc.?                                                      Yes       No
Do you have over a 2.5 cumulative Concord University GPA?                                                               Yes       No
Do you have federal and/or state work-study?                                                                            Yes       No
Do you have part or full-time employment (off-campus)?                                                                  Yes       No
How many hours do you have towards graduation? _____________________
How many hours are you taking during the semester you are applying for reinstatement? _____________________
Estimated Family Contribution (EFC) for 2008-2009? _____________________
Are you being called to active military service?                                                                        Yes       No
Are you applying because of a medical reason?                                                                           Yes       No
(If Yes, please provide medical documentation.)
Are you currently on the Concord University monthly payment plan (Fall/Spring semesters)?                               Yes       No

The Student will be notified within 15 working days from the date of this application regarding the review by the Admissions
Office.


____________________________________________________                          ________________________________________________
                   Student Signature                                                                Date

                                                Admissions Office • Marsh Hall Room 206
                                              Toll-Free 1-888-384-5249 • FAX 304-384-3218
                                                      E-Mail: kgamble@concord.edu
                                        Campus Box D-127 • PO Box 1000 • Athens, WV 24712-1000