Financial Aid Office; Room 241 North
695 Park Avenue New York, NY 10065
Tel. (212)-772-4820
Fax (212)-650-3666
STUDENT INFORMATION
EMPLID: __________________________________
D.O. B: _______/______/______
Last Name: ________________________ First Name: ___________________________ Middle Initial: _______
The student must have a valid 2016-2017 FAFSA on file to request a Federal Pell grant disbursement for summer 2016.
The summer 2016 Pell grant eligibility will be determined based on your 2016-2017 FAFSA and other information such as Pell
Lifetime Eligibility Usage (LEU). Students that are eligible for a Pell grant award from the 2015-2016 academic year will not be
eligible to receive a Pell award from the 2016-2017 academic year.
Select one of the following:
I am graduating at the end of summer 2016.
I am graduating at the end of fall 2016.
I will be registered for the fall 2016 and/or spring 2017 semesters as a part-time student (less than 12 credits).
I will be enrolled as a full time student for the fall 2016 and spring 2017 semesters.
 Students must be registered in order to receive Pell funding for summer 2016. In addition, students must be making
Satisfactory Academic Progress in order to receive federal financial aid.
 Failure to maintain enrollment or make Satisfactory Academic Progress, may result in a tuition liability for any and/or
all outstanding charges for summer 2016.
 Student’s spring 2017 Pell grant will be reduced.
Federal Pell grant eligibility is restricted to a maximum of 12 full-time semesters (600%)
Effective with the 2013-2014 award year, the calculation of the duration of the students Pell grant eligibility will include ALL years the
student has received federal Pell grant funding. Your Pell grant duration will be determined by adding together each of your annual
percentages of the scheduled awards that were disbursed to you. A student enrolled full-time throughout the fall and spring semesters
would earn 100% of their Pell grant each year. You can view your Pell Lifetime Eligibility Usage at www.nslds.ed.gov
STUDENT’S CERTIFICATION AND AGREEMENT
My signature below certifies that I understand the federal aid requirements and that this is a request for a summer 2016 Pell grant.
Student Signature: __________________________________________________________________ Date: ____________________
OFFICE USE ONLY
COD Pell LEU: ________%
Summer 2016 Pell
Ineligible for summer 2016 Pell. Reason: _____________________________________________________________________
FA Advisor’s Signature: ________________________________________________________________ Date: ____________________