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Student Affairs
Financial Hardship Worksheet
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
List all Roommates
List all Roommates
Item weight
Add more items
more items
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