Data Form (Fill and Print) - Louisiana Tech University

LOUISIANA TECH UNIVERSITY
FINANCIAL AID DATA FORM: AWARD YEAR 2011-2012
Complete and return to: P.O. Box 7925, Ruston, LA 71272
Last Name: First Name: Middle Initial:
Social Security Number :
Current Mailing Address
Street/Box:
City: State: Zip: Phone#:
Be sure you provide an address
where the mail will be acted upon
immediately after receipt.
(Include area code)
E-Mail:
Cell Phone#:
Access Code Designation
The code you enter below may be used by you and those persons whom you wish to have access to your financial aid records. Persons
using the code in conjunction with your Social Security number or CWID may call or visit our office and obtain information on your
financial aid status and the data in your file. You may also use this code to access your record through our web site. If you have already
designated a code, you do not have to complete this block. Your code will remain in effect until rescinded or a new code is provided in
writing by you, the student. Care should be exercised to secure this access code. Unauthorized use of this code by others could lead to
identity theft from financial aid data.
ACCESS CODE: Enter a combination of 4 alpha / numeric characters
Beginning Freshman
Please provide your cumulative High School GPA.
We prefer it to be based on the Board of Regents CORE or TOPS requirements.
High School GPA:
I am an undergraduate student enrolled in an Associate or Bachelor's program. I will graduate:
month
year
Note: If you will complete an undergraduate degree during this year and enter graduate school, you must provide the Financial Aid Office a
copy of your unconditional admission to graduate school so that we may continue to process financial aid.
I am a graduate student enrolled in an Master's or Doctoral program. I will graduate:
month
year
School Term (Quarter)
Fall 11 (Sept - Nov)
Winter 11-12 (Dec - Feb)
##
#Credit Hours Planned
Housing Plans
Housing Codes:
Choose code.
1 = On Campus
2 = With Parents
3 = Off Campus
(not with parents or relatives)
Spring 12 (March - May)
Summer 12 (June - Aug)
Full-time credit hours are 8+ (undergraduate)
Half-time credit hours are 4+ (undergraduate)
6+ (graduate)
3+ (graduate)
Applying for TOPS ONLY If you do not want to be considered for federal financial aid, complete the first page of this form, sign
below, and return this form. You do not have to complete the remainder of the form nor return any other forms to us.
Student Signature:
NOTE: By completing the FAFSA and the entire Tech Data Form, you are automatically considered for federal grants (Pell Grant, SEOG
Grant, Louisiana GO Grant, Louisiana LEAP Grant, and all Direct Federal loans).
faf1112013 rev 01/26/11
This document will be returned to you if it is not completed correctly.

Loan Information : Beginning on July 1, 2010, the University began participating in the William D. Ford Federal Direct Loan
program, in which borrowers obtain loan funds directly from the U.S. Department of Education. This includes Federal Stafford,
Federal PLUS, and Federal Graduate PLUS loans. If you plan on receiving Federal Stafford loans at Louisiana Tech and did not have a
Federal Direct Stafford loan disbursement in 2010-2011, you will need to complete a Stafford Master Promissory Note (MPN) and
Stafford Entrance Counseling at www.studentloans.gov . You will need your FAFSA PIN to sign in to Manage My Direct Loan.
List any financial assistance you expect to receive to attend Louisiana Tech this year. (Enter name and $ per quarter).
Include assistance such as Vocational Rehabilitation, Barksdale tuition assistance, Americorp, and National Guard Fee Waivers.
Financial Aid/
Scholarships
Fall
$
Winter
$
Spring
$
Summer
$
Financial Aid/
Scholarships
Fall
$
Winter
$
Spring
$
Summer
$
List any educational institutions you have attended since high school. List your most recent school first (include Louisiana Tech).
Write "NONE" in the first line of the section if you have not attended any other institutions. Attach an additional sheet if needed.
Full Name of School City State From (mm/yyyy) To (mm/yyyy)
Child Care Costs: If you will incur child care costs, your care provider must furnish a signed statement on their business letterhead
indicating the amount you pay or will pay per child. Submit the information as soon as possible to allow the costs to be included in
your total Cost of Attendance. List the number of children in each age group for which you will incur costs.
0-5 years of age
6-12 years of age
13 years of age and older
Aviation Costs: If students who have Aviation as a major, plan to take any of the following PRAV flight courses with associated fees,
please indicate the quarter in which you plan to take the course this year (F for Fall, W for Winter, SP for Spring, and SU for Summer).
Check with your advisor prior to selecting the courses. You must be enrolled in the course to receive the budget increase.
110
111
242 243 342 343 344 411 480
I permit Louisiana Tech University to use any Title IV federal aid I receive to pay any institutional fees, charges, and fees related to my
attendance at Louisiana Tech University. This permission pertains to charges for the award year for which I am receiving financial aid
and minor prior year charges up to $200. I understand that I may rescind (in writing) this permission at any time. Allowable charges
include tuition and fees, residence hall rent, meal plans, debit card (Tech Express), late registration fee, returned check fee, library
fines and lost book charges, traffic fines, application fee, housing room deposit, miscellaneous housing charges and fines, SGA loans,
bookstore charges, athletic book charges, married student housing rent, lost ID card fee, and various departmental charges and fines.
Student's Signature
-- I understand I must meet the satisfactory academic progress requirements for Louisiana Tech University in order to be eligible for
and retain federal financial aid.
-- I acknowledge receipt of a copy of the Satisfactory Academic Progress Policy by initialing on this line.
INITIALS
-- I certify that the above information is true and correct to the best of my knowledge. If this form has been completed with intent to
receive federal financial aid on the basis of false or incomplete information, I understand that I am subject to denial of aid and
possible federal prosecution.
Applicant's Signature
Date
faf1112013 rev 01/26/11
Date