Financial Aid

 

Withdrawal Form--The date this form is completed by the University will be the effective date of withdrawal.

Please print, complete, and return this form to:

Missouri Southern State University Financial Aid Office
3950 E. Newman Road
Joplin, MO 64801-1595

FAX: 417.659.4474
PHONE: 417.625.3170
EMAIL:  finaid@mssu.edu

  • Name  of Student: ______________________________________________
  • Social Security Number: _____________________
  • Permanent Mailing Address: ________________________________________________
    (Street -- City -- State -- Zip)
  • EMAIL:   ________________________________________
  • Phone number: ________________________
  • Withdrawal Semester: 
    Fall _________ Spring _______ Summer ________
  • Reason(s) for Withdrawl
    ________________________________________ ________________________________________
  • Bookstore Initials _______________

    CONSEQUENCES OF WITHDRAWAL

    As of August 21, 2000, the Department of Education requires students to repay a portion of their Federal Funds until 60% of the semester is completed. Early withdrawal from all classes will result in a computation of the amount of money you owe the Federal Government from the Financial Aid funds you received. If you do not repay these funds in less than forty-five (45) days you will be suspended from all Federal Aid at all Colleges and/or Universities until all of the funds (plus interest) are repaid.
    Please read the full Consequences of Withdrawal.

Please circle the choices that apply:

  • You want to cancel all fin/aid and pay the charges owed to MSSU.

  • You want to cancel your loan only.**

  • You want to accept only enough fin/aid to cover the charges owed to MSSU**

  • You want all fin/aid and excess sent to you**

**Acceptance of any Federal Financial Aid award will result in Federal Financial Aid Suspension.

I have read and understand the statement regarding the consequences of withdrawal, and have selected my financial aid preferences.

Signed ____________________________ Date __________
(Student)

ATTENTION:

If you have direct loans, you will need to fill out these exit counseling pages. At the end of the exit counseling session, you must print the Borrowers Information and Rights & Responsibility Summary Checklist and mail or fax it to Missouri Southern State University.

Missouri Southern State University Financial Aid Office
3950 E. Newman Road
Joplin, MO 64801-1595

FAX: 417.659.4474

FOR OFFICE USE ONLY

Counseling..................................._____
Financial Aid................................_____
Business Office............................._____
Housing........................................_____
Library........................................._____
Security........................................_____
International Student......................._____
Athletic Compliance......................_____
Music..........................................._____

College Exit Counselor Initials_________
_____________________________________________
_____________________________________________

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