2023-2024 Loan Cancellation Form

2023-2024 Loan Cancellation Form
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.
Cancellation Amount
I would like to cancel the specified loan(s) for the following semesters:

(Please specify the appropriate dollar amount for each semester below or check the box "Cancel all loans for 2023-2024" if you wish to cancel all loans for the year. The loan processor will always decrease unsubsidized loans first and subsidized loans last.)

Check the box(es) that apply:

	Check the box(es) that apply	PLUS Loan Cancellation	Unsubsidized Loan Cancellation	Subsidized Loan Cancellation
Fall 2023
Spring 2024
Summer 2024

OR

Cancel all loans for 2023-2024
Reason for Cancellation
Please explain why you are cancelling or returning part of the loan:
Student Signature
Submitting this application via Jotform constitutes your electronic signature. This application shall be deemed for all purposes to have been "signed" and will constitute an "original" when printed from electronic records established and maintained by the Office of Financial Aid and Scholarships, if an electronic signature is contained.*

Clear
Date

MonthDayYear
Date
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 | Email: financial_aid@heritage.edu
Should be Empty:

Student Information