Faculty Scholarship Chair Sign-off

Emergency Loan Fund for Health Rehabilitative & Sciences

Print, fill out, sign and then send to Geraldine Peixoto in Foundation

Instructions: It is the student's responsibility to ensure that the sign-off form is fully completed and signed by financial aid as well as nursing department chairs, allied health department chair, dental health department chair or rehabilitative health chair prior to attaching it to the application form and sending it to the Dean of Health and Rehabilitative Sciences. The document will then be sent to the office of institutional advancement. Incomplete applications will not be considered for funding.

Note to Department Chairs: It is the student's responsibility to ensure that the sign-off form is fully completed and signed by financial aid and one of the following department chair: Nursing, Allied, Dental and Rehabilitative Health, prior to attaching it to the application form and sending it to the Dean of Health and Rehabilitative Sciences. The document will then be sent to the office of institutional advancement. Incomplete applications will not be considered for funding.

It takes two weeks for a check to be issued. the check is automatically sent to the student's home address via certified mail as soon as it is processed.

FINANCIAL AID OFFICE

Applicant has applied for Financial Aid. Yes___ No___

Applicant is eligible for Financial Aid. Yes___ No___

Applicant is eligible for more financial aid than he/she is receiving. Yes___ No___

Financial Aid Officer / Date

NURSING, ALLIED, DENTAL AND REHABILITATIVE HEALTH DEPARTMENT

_____ I recommend approval of the loan in the amount of $___________

_____ I do not recommend approval of the loan.

Nursing, Allied Health, Dental Health or Rehabilitative Health Dept. Chair

______________________________________________
Signature/Date

Dean of Health and rehabilitative Sciences

___________________________________
Signature/Date

OFFICE OF INSTITUTIONAL ADVANCEMENT/CCRI FOUNDATION

1. Is Application form attached? Yes___ No___

2. Are funds available to support the enclosed loan request? Yes___ No___

3. List account balance before request. $___________

4. List amount of request. $___________

5. List balance after request. $___________ Fiscal year: July 1, ____to June 30, ____


____________________________________
Director of Institutional Advancement / Date