2023-2024 Budget Adjustment Request Form

2023-2024 Budget Adjustment Request Form
Campus Location*
Budget adjustments are for special and unusual expenses that differentiate the student from other students. Submitting a request does not automatically ensure that your budget will be increased. Each submission is reviewed on a case-by-case basis. Please allow ten to fifteen business days for teh completion of the process upon receipt of all required supporting documentation. Budget Adjustments can only be made to cover costs incurred during the student's period of enrollment.
Student Information
Name*

First NameLast Name
Student ID*
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Phone Number
Please enter a valid phone number.
Required documents to be submitted by the student
Students are required to submit the following information:
- Budget Adjustment Request Form
- Room & Board: Copy of signed lease or monthly mortgage statement, 3 months of utility bills, and food cost estimate along with name and ages of all dependents. If you have dependents outside of immediate family members, proof of legal guardianship is required.
- Transportation: Car insurance bill, quote or receipt from auto repair or maintenance worker, or address for more than 44 mile round trip travel.
- Computer Expense: Purchase receipt, invoice, or quote.
- Dependent Care: Contract or statement from provider indicating the dependent's name and the amount paid per month.
- Medical/Dental/Optical services not covered by insurance: Copies of billing statements, cancelled checks, or written estimate from your physician.
- Moving Expenses: Copy of invoice/receipt for U-Haul, plane or train ticket, or addresses for mileage, copy of invoice/receipt for hotel/motel stays in the student's name.
Budget Adjustment

	Adjustment Amount
Room and Board
Fees
Auto Repairs
Car Insurance
Dependent Care
Computer Expense
Moving Expenses
Medical/Dental/Optical

To From

Car Mileage
Upload Supporting Documentation
The items you need to upload are provided above. *

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Financial Aid Adjustment
Please select one of the following options:

If an adjustment is processed, I would like for the federal student loans in my financial aid package to be automatically increased by the amount of the adjustment.If an adjustment is processed, I would like for my federal student loans to NOT be automatically increased.If not, I am requesting the following amount:
Amount:
For Graduate Students Only
If this adjustment results in an increase to my Graduate PLUS Loan, I consent to the U.S. Department of Education and its agents obtaining a report of my credit record and using the information from that report in determining whether to make a Direct PLUS Loan to me. I understand that I will be notified in writing of the results of the credit check with respect to my loan application.
Student Signature and Certification
I have read and understand the entire budget adjustment policy published online. I acknowledge the information I am submitting is true, accurate and real. If I am found to have submitted false documentation, I understand it can result in financial aid penalties.*

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HAVE QUESTIONS ABOUT YOUR FINANCIAL AID?

Financial Aid Office Contact Information

Address: Attn: Financial Aid Office 3240 Fort Rd., Toppenish, WA 98948 | Phone: (509) 865-8502 | Fax: (509) 865-1853 | Email: financial_aid@heritage.edu
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2023-2024 Budget Adjustment Request Form

Student Information

Required documents to be submitted by the student

Budget Adjustment

Upload Supporting Documentation

Financial Aid Adjustment

For Graduate Students Only

Student Signature and Certification