STUDENT CASH ADVANCE

Students must be enrolled during the semester in which they apply for a cash advance. Incoming students may not be eligible for a cash advance until the add/drop period has ended. Students can apply for a cash advance once per semester, and may only have one outstanding advance at a time. Process time for applications is five business days. Spring 2017 applications will begin being processed on December 9, 2016 (but will not be processed between 12/22/16 and 1/2/17). If completing electronically, save the form before e-mailing it to: .

*Please fill out the form in its entirety and attach any necessary documentation.

(If you are unable to enter information through Microsoft Word, please click on Tools > Macro > Security, set to “Low”, and reopen the file. You may revert back to a higher level of security after saving and completing the form.)

Contact Information:

Name: Student ID number:

Address:

Phone Number: E-mail:

Program: Expected Graduation Date:

Amount Requested: ($1,000.00 maximum; only one loan at a time)

Please explain your emergency situation (for example: loss or reduction in employment; medical emergency; unexpected

or unplanned expenses due to unforeseen event); and how do you plan to repay the advance by the repayment deadline?

Please check the box to verify that you have read and understood the conditions of the loan, and sign below. Return this form to the Student Affairs Office, Mission Building, Room 401; or save the completed form and email it to .

I would like my cash advance check to be held at the business office for pickup
I would like my cash advance check to be mailed to the address listed above

I will repay my cash advance by submitting a check to the Business Office payable to CIIS by February 28, 2017
I authorize the CIIS Business Office to deduct my cash advance amount from my Spring 2017 Financial Aid disbursement.

I understand that the cash advance must be repaid and a hold will be assigned if the cash advance becomes past due.

Signature: Date:

(If filling out electronically, enter your whole name)

For inquiries about the status of your cash advance request, please contact . We will use the email address you provided above to contact you with updates regarding your advance status.


FOR OFFICE USE ONLY:

Dean of Students approval:

Name: (please print)

Signature: Date:

Comments

Financial Aid Office verification:

Yes, the student above is receiving Financial Aid through CIIS in Spring 2017
No, the student above in NOT receiving Financial Aid through CIIS in Spring 2017

Financial Aid Staff Name: (please print)

Signature: Date:

Comments