Declining Federal Pell Grant Funds
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1Office of Financial Aid
2017-2018
130 Student Union
3640 Colonel Glenn Hwy.
Declining
Dayton, OH 45435-0001
Phone: (937) 775-4000
Federal Pell Grant Funds
E-mail: raiderconnect@wright.edu
FAX: (937) 775-4410
Effective the 2012-2013 aid year, the Federal Pell Grant program has a maximum lifetime limit of 12 semesters (or its
equivalent). You can access your
NSLDS
record online with your
FSA
ID. Your NSLDS record will display all of the
federal student loans and grants you have received . Students have the right to decline Pell Grant funds during the
academic year to preserve eligibility for future enrollment periods.
If you wish to decline or return all or part of a Federal Pell Grant disbursement that you are otherwise eligible to receive,
you must submit this completed form to Raider Connect. You may decline the Federal Pell Grant funds for one or more
semesters within the current aid year.
Once the form is received, the Office of Financial Aid will update the Federal Pell Grant amount. You will receive an e-
mail notification to your Wright State University e-mail address once the adjustment has been processed.
I.
Student Information
(Please print)
U
0
0
Student Name:
UID:
@wright.edu
Phone Number:
Email:
II.
Federal Pell Grant Information
Check the appropriate term that you would like to decline Federal Pell Grant funds for and indicate the Pell Grant amount
that you wish to decline. You may view your Federal Pell Grant eligibility online via the Financial Aid and Scholarship
section of WINGS Express.
Term
Pell Grant Award Amount
$ ______________________
Summer 2017
$ ______________________
Fall 2017
$ ______________________
Spring 2018
III.
Certification Statement
I hereby decline or reduce the 2017-2018 Pell Grant funds for which I am otherwise eligible for and I understand that
these funds may not be available once the award year is over.
Student Signature: ________________________________________________
Date: ____________________
FOR OFFICE USE ONLY
PELLDC
RPAAWRD
REAOR18
PELLDC
PELL DECLINE FORM
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