* Is this for the summer or the academic year? Please select summer academic year

Please fill in the year that you are requesting for.
* Academic Year (i.e. 2013-2014) or Summer (i.e. Summer 2013):

* Student Name:

Student Mailing Address:

* Student ID #:
DO NOT USE STUDENT SOCIAL SECURITY # FOR ID

Student HRMS Employee ID #:

* Student Phone #:

* Student CU E-mail Address:

* Employer Name (Dept/Agency):

* Employer Address/Campus box:

* Employer Phone #:

Employer Fax #:

* Supervisor Name:

* Supervisor E-mail:

Please provide the following information so that we can process your request:

Is this student currently working for your department? Yes No

If yes, what was the student's start date? (MM/DD/YY)

Do you have hourly earnings to transfer for the student? Yes No

If the student's only financial aid eligibility consists of accepted loans, he/she is willing to decline loans in the following amount:

$

(Note: Loan funds that have already disbursed must be repaid to the Bursar's Office)

• Completion of this form does not guarantee an award.
• If we are unable to grant the request upon receipt, it is kept on file should funds become available.
• Students must have remaining financial aid eligibility to be considered for an award.
• Students are notified of an award with a revised award letter.
• Employers are notified with a letter or email.