| TOTAL WITHDRAWAL ESTIMATE |
| Student: &nbs=
p; |
Jane Doe |
|
|
|
|
|
SS# |
123-45-6789
| |
|
| Withdrawal
Date: |
|
10/28/2010 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| |
|
|
Amount that could |
|
|
|
|
|
|
| Amount
Disbursed |
|
have been disbu=
rsed |
|
|
Withdrawal Date |
10/28/10 |
|
| Un=
subsidized
Loan |
$243.10 |
|
|
$0.00 |
|
|
|
|
|
| Su=
bsidized
Loan |
$870.15 |
|
|
$0.00 |
|
|
|
Period of Enrollment (Semester)
| |
| PL=
US Loan |
$0.00 |
|
|
$0.00 |
|
|
|
Start Date |
8/17/10 |
|
End Date |
12/20/10 |
| Pe=
ll Grant |
$2,750.00 |
|
|
$0.00 |
|
|
|
|
| SE=
OG Grant |
$0.00 |
|
|
$0.00 |
|
|
|
73 |
|
126 |
|
57.9% |
| AC Grant |
|
$0.00 |
|
|
|
|
|
Completed Days |
&nbs=
p;
/ |
Total Days |
=3D |
% Earned |
|
TOTAL
| $3,863.25 |
|
+ |
$0.00 |
|
=3D |
$3,863.25 |
Days |
|
|
|
|
|
|
|
| Percentage of Title IV Aid Earned=
|
|
|
|
| If cal=
culated
amount is less than or equal to 60.0% enter it in Box C (round to tenth),
otherwise enter 100% &nbs=
p; &=
nbsp;
C |
57.9% |
|
|
|
| |
|
|
| Amount =
of Title IV
Aid Earned by the Student |
|
| 57.9%<=
/td>
| * |
$3,863.25 |
=3D |
&nbs=
p;
D |
$2,236.82 |
|
|
|
|
| Total Ti=
tle IV Aid
to be Disbursed or Returned |
|
|
| Post-wit=
hdrawal
disbursement. |
|
|
| $2,23=
6.82 |
- |
$3,863.25 |
|
E |
$0.00 |
|
|
|
| Title IV=
aid to be
returned |
|
|
| $3,86=
3.25 |
|
$2,236.82 |
|
F |
$1,626.43 |
|
|
|
| Amount =
of Unearned
Title IV Aid Due from the School |
|
|
| Tuition
and Fees |
$704.05 |
|
|
|
|
|
| Percentage
of Title IV aid unearned |
H |
42.1% |
|
Enter the less=
er amount
of Box F or Box I |
J |
$296.41 |
| 704.05=
|
* |
42.1% |
=3D |
I |
$296.41 |
|
|
|
|
|
|
|
|
|
|
|
| Return =
of Funds by
the School |
|
|
|
| Amt for School=
to Return |
Amt School can=
Keep |
|
|
|
| Un=
subsidized
Loan |
$243.10 |
|
|
$0.00 |
|
|
|
|
| Su=
bsidized
Loan |
$53.31 |
|
|
$816.84 |
|
|
|
|
| PL=
US Loan |
$0.00 |
|
|
$0.00 |
|
|
|
|
| Pe=
ll Grant |
$0.00 |
|
|
$2,750.00 |
|
|
|
|
| SE=
OG Grant |
$0.00 |
|
|
$0.00 |
|
|
|
|
| TOTAL |
RETURNED |
$296.41 |
|
KEPT |
$3,566.84 |
|
|
|
|
| Initial=
Amount of
Unearned Title IV Due from the Student |
|
|
| F |
$1,626.43 |
- J<=
/td>
| $296.41 |
=3D K |
$1,330.02 |
|
|
|
|
|
|
|
|
|
|
|
|
| Return =
of Funds by
the Student |
|
|
|
| U=
nsubsidized
Loan |
$0.00 |
|
|
|
| Su=
bsidized
Loan |
$816.84 |
|
AMOUNT STUDENT=
MUST PAY
BACK TO CCAC |
|
$296.41 |
| PL=
US Loan |
$0.00 |
|
|
|
|
|
|
| Pe=
ll Grant |
$513.18 |
* 5=
0% =3D |
$256.59 |
|
AMOUNT STUDENT=
MUST PAY
BACK TO DOE |
|
$256.59 |
| S=
EOG Grant |
$0.00 |
* 5=
0% =3D |
$0.00 |
|
|
|
|
| |
|
| By
signing this ESTIMATE you
are verifying that you understand what your financial responsibility can =
be
to CCAC and the Department of |
|
|
Education and =
you have
received a copy of this estimate |
| |
|
|
|
|
|
|
|
|
|
|
| St=
udent
Signature |
|
Date |
|
|
| |
|
|
|
|
|
|
|
|
|
|
| Fi=
nancial
Aid Administrator Signature |
|
Date |
|
|
|
| |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
------=_NextPart_01CACA9A.FABE4BB0
Content-Location: file:///C:/AEC812E5/WithdrawalEstimate_files/filelist.xml
Content-Transfer-Encoding: quoted-printable
Content-Type: text/xml; charset="utf-8"