Financial Hardship Worksheet

Indicates required field

Instructions

This form can only be considered for review if all fields are completed and accurate documentation is provided. This form must also be accompanied by the Housing Exemption Financial Aid Information Form.

Forms with incomplete information will not be able to be used in the review. Note that financial savings are not grounds for an exemption for financial hardship.

First Name

Last Name

PID

Ohio Email

Yearly Financial Resources

Savings

Employment Earnings

Aid from Parents

Aid from Others

Work Study

Grants

Loans

Scholarships

Trusts

Other

Total

Yearly Expenses On Campus

Tuition/Fees On Campus

Books/Supplies On Campus

Room/Board On Campus

Transportation On Campus

Other Expenses On Campus

Total On Campus

Yearly Expenses Off Campus

Tuition/Fees Off Campus

Books/Supplies Off Campus

Room/Board Off Campus

Transportation Off Campus

Other Expenses Off Campus

Total Off Campus

Monthly Off Campus Expenses

Rent

Food

Electric

Gas

Water/Sewer

Internet

Trash

Transportation

Monthly Total

Semester Total

Monthly total x 3 =

Proposed Residence/Landlord Information

Do not sign an off-campus lease.If a lease has already been completed, it should accompany this request. Signing a lease is
not recommended until you have received confirmation of exemption from Housing and Residence Life and does not guarantee
an exemption.

Landlord Name

Landlord Phone

Term of Proposed Lease

9 months, one year, etc.

Proposed Address

Roommates:

List all Roommates

more items

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