RETURN OF TITLE IV FUNDS AND WITHDRAWAL RECORD
STUDENT'S NAME:
Jane Doe
CID#
18083451
DATE OF THE INSTITUTION'S DETERMINATION THAT THE STUDENT WITHDREW:
INSTITUTIONAL CHARGES/COSTS AND TOTAL AID RECEIVED
Amount Disbursed
TUITION:
$3,172.00
PELL:
FEES:
$0.00
ACG:
ROOM:
$2,252.00
NSG:
BOARD:
$1,566.00
SEOG:
OTHER:
$0.00
TEACH
L.TOTAL:
$6,990.00
A.Total
PERKINS:
UNSUB STAFFORD:
SUB STAFFORD:
PLUS: (Parent)
Plus: (Grad)
OTHER:
B.TOTAL:
03/17/14
$2,822.00
$0.00
$0.00
$0.00
$0.00
$2,822.00
Could have been disbursed
PELL:
ACG:
NSG:
SEOG:
TEACH
C.Total
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$2,969.00
$1,732.00
$0.00
$0.00
$0.00
$4,701.00
PERKINS:
UNSUB STAFFORD:
SUB STAFFORD:
PLUS: (Parent)
Plus: (Grad)
OTHER:
D.TOTAL:
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
PERCENT OF PAYMENT PERIOD COMPLETE
BEGIN DATE:
1/13/2014
WITHDRAWAL DATE:
END DATE:
5/9/2014
SPRING BREAK:
3/8/2014 3/16/2014
DAYS ATTENDED:
=% COMPLETED:
3/17/14
E.Total aid disbursed
F.Total grant aid disbursed and
could have been disbursed
$2,822.00
55 /DAYS IN PAYMENT PERIOD:
50.93%
108
G.Total aid disbursed and
could have been disbursed
PERCENT AND AMOUNT OF EARNED AID
IF % COMPLETED < OR = 60%, THEN EARNED AID =:
IF % COMPLETED > 60%, THEN EARNED AID =:
TOTAL AID DISBURSED:
$7,523.00 X % EARNED:
& COULD HAVE BEEN DISBURSED (G)
50.9%
100%
51% =EARNED AMT:
$3,831
PERCENT AND AMOUNT OF UNEARNED AID
100.00% LESS
51% EARNED AID =
TOTAL AID DISBURSED:
$7,523.00 X % UNEARNED:
& COULD HAVE BEEN DISBURSED (G)
49% UNEARNED AID
49% =UNEARNED AMT:
$3,692
POST-WITHDRAWAL DISBURSEMENT:
Aid earned by the student
$3,831 Less
Total aid disbursed
If aid earned is greater than total disbursed go to post-withdrawl disbursement
If aid earned is than total disbursed go to aid to be returned
If aid earned is equal to total disbursed stop
$7,523.00
$0.00
3,831
$3,692
AMOUNT OF AID TO BE RETURNED:
Total aid disbursed
$7,523.00 Less aid earned by the student
AMOUNT OF AID THE INSTITUTION MUST RETURN
TOTAL COST:
$6,990.00 X % UNEARNED:
49%
=UNEARNED % APPLIED TO COST:
$3,430
THE LESSER OF:
UNEARNED AID AMOUNT OR UNEARNED % APPLIED TO COST =:
RETURN:
UNSUB STAFFORD
SUB STAFFORD
PERKINS
PLUS (Grad)
PLUS (Parent)
$2,969.00
$461
$3,430 AMT RET
PELL
ACG:
NSG:
SEOG:
TEACH:
Other
AMOUNT OF AID THE STUDENT MUST RETURN
UNEARNED AID:
$3,692 LESS AMOUNT RETURNED:
$3,430
AMOUNT STUDENT RETURNS:
$262
LOANS STUDENT RETURNS:
$262
GRANT FUNDS TO BE RETURNED
INITIAL AMOUNT OF GRANTS TO BE RETURNED:
TOTAL AMOUNT STUDENT RETURNS LESS LOANS STUDENT RETURNS=
PROTECTED AMOUNT =TOTAL GRANTS
$2,822.00 X %
50%
INITIAL AMOUNT OF GRANTS TO BE RETURNED LESS PROTECTED AMOUNT=
RETURN:
UNSUB STAFFORD*
SUB STAFFORD*
PERKINS*
PLUS (Grad)*
PLUS (Parent)*
*repaid according to loan terms
$7,523.00
$0.00
$1,411.00
$0.00
PELL**
$262 ACG:**
NSG:**
SEOG:**
TEACH**
Other**
**amounts less than $50 per program
do not have to be returned.
$7,523.00