College of DuPage Office of Student Financial Assistance 2016‐2017 No Attendance/ No Financial Assistance Processing Statement Last Name: Student ID: First Name: The Office of Student Financial Assistance has received the results of your Free Application for Federal Student Aid (FAFSA). Financial Assistance includes the following awards: Federal Pell Grant, Federal SEOG, Federal Work Study (FWS), Illinois MAP Grant, STS Grant, and Federal Direct Student Loans. Check the appropriate box(es) that applies to your situation. If this form is incorrectly completed, your financial assistance may be completely removed until we receive a corrected statement. I do not plan on attending the College of DuPage for the following semesters: (Check all that may apply.) 2016 Fall 2017 Spring 2017 Summer ‐ OR ‐ I am currently attending the College of DuPage but do not want financial assistance processed for the following semesters: (Check all that may apply.) 2016 Fall 2017 Spring 2017 Summer By signing this statement, I understand and authorize the Office of Student Financial Assistance to STOP the processing and cancel any and all financial assistance for the terms I have selected. If any grant or loan monies have been applied to my account, I accept FULL responsibility for paying my tuition and fees as well as any other charges that have been posted to my account as a result of grants or loan monies being backed off. Student Signature Date
Please note: If you would like to withdraw this statement at any time, you will need to submit a new written statement stating your name, student ID number, and the changes in your attendance or processing. If documents are still needed to complete the financial aid process, you must submit them with your reinstatement request. This form is to be used by students who choose not to attend the College of DuPage during a specific academic year or do not want to receive financial assistance during their attendance in a specific academic year or term. Students have the right to rescind this request in writing at any time. Students understand and accept the responsibilities related to submitting this form to the Office of Student Financial Assistance. These responsibilities include but are not limited to the following: 
Cancellation of any and all Financial Assistance posted to the student’s account for a specific academic year or term. 
Responsibility to pay out of pocket to the College of DuPage any balance owed on the student’s account. Processing of this form may take up to a week for the cancellation of the student’s Financial Assistance not needed at the College of DuPage. It may take additional time during peak processing. Please allow adequate processing time if you plan to attend another school and need your Financial Aid cancelled prior to your transfer. Please return this form to: College of DuPage, Office of Student Financial Assistance – SSC 2220 425 Fawell Blvd., Glen Ellyn, IL 60137 FAX (630) 942‐2151 EMAIL: financialaid@cod.edu The college will not discriminate in its programs and activities on the basis of race, color, religion, creed, national origin, sex, age, ancestry, marital status, sexual orientation, arrest record, military status or unfavorable military discharge, citizenship status, physical or mental handicap or disability (Board Policy 5010; 20‐5). 2016‐2017 No Attendance/No Financial Assistance Processing Statement 02/2/16