Outside Scholarship Notification and Release Form

If you are receiving a scholarship from an outside organization, please complete this form. If the check is given to you, please submit the check along with this form to the Financial Aid Office. Be sure to endorse the check if it is made payable to you and Loyola University Chicago. Make copies as needed and use one sheet per scholarship check. Please keep a copy of this form and a copy of the check for your records. If the donating agency is sending the check directly to Loyola University Chicago, please have the check directed to the address below. Also, it is appropriate and highly recommended that you send a Thank you note to the providing donor/agency.

Student Name Student Name First Last
UVID
Must be between 1 and 11 digits. Currently Entered: 0 digits.
Permanent Address Permanent Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Loyola Email
Phone Phone - ### - ### ####
Academic Year
Scholarship Donor/Agency
Donor/Agency Contact person
Donor/Agency Phone Donor/Agency Phone - ### - ### ####
Amount of scholarship
Is this scholarship restricted to tuition only?

Is this scholarship restricted to tuition only? Yes No
Please check the appropriate disbursement plan If you do not know if your scholarship is for a specific term, the entire amount will be applied to the current semester so long as it does not exceed the term Cost of Attendance (COA) budget.:

Please check the appropriate disbursement plan If you do not know if your scholarship is for a specific term, the entire amount will be applied to the current semester so long as it does not exceed the term Cost of Attendance (COA) budget.: Disburse evenly across all terms of enrollment Disburse to summer only Disburse to fall only Disburse to spring only
FERPA Release Form-Scholarships

Pursuant to the Family Educational Rights and Privacy Act (FERPA) of 1974, as amended, the University cannot disclose personally identifiable information contained in the student's education records without the student's written consent, except to the extent that FERPA authorizes disclosure without consent. A scholarship organization does not have the automatic right to view a recipient's records without the expressed written consent of the student.
I authorize the release of allof my records maintained by the Financial Aid Office at Loyola University Chicago to the scholarship organization listed above for the purposes of confirming my eligibility and applying funding to my account. Records maintained in other offices will not be disclosed due to this authorization. In giving this authorization, I knowingly and willingly waive all privacy and confidentiality rights to which I am entitled under Federal, State, or Local law or under UNiversity rules, regulations, statues or policies. I further agree to hold the Board of Trustees of Loyola University Chicago, its officers, employees, representatives, agent and assignees free and harmless from any and all lawsuits or causes of action which may arise as a result of this authorization. I further understand that the FERPA request will remain valid unless revolked. I may revolk this consent at any time upon written notice to the Financial Aid office at Loyola University Chicago.

I authorize the release of allof my records maintained by the Financial Aid Office at Loyola University Chicago to the scholarship organization listed above for the purposes of confirming my eligibility and applying funding to my account. Records maintained in other offices will not be disclosed due to this authorization. In giving this authorization, I knowingly and willingly waive all privacy and confidentiality rights to which I am entitled under Federal, State, or Local law or under UNiversity rules, regulations, statues or policies. I further agree to hold the Board of Trustees of Loyola University Chicago, its officers, employees, representatives, agent and assignees free and harmless from any and all lawsuits or causes of action which may arise as a result of this authorization. I further understand that the FERPA request will remain valid unless revolked. I may revolk this consent at any time upon written notice to the Financial Aid office at Loyola University Chicago. Yes, I give my authorization for release of my information to the individual named above. No, I do not give my authorization for release of my information to the individual named above.
Draw your signature into the box below. Signatures cannot be typed or stamped. They must be drawn.

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.

Outside Scholarship Notification and Release Form

Outside Scholarship Notification and Release Form

FERPA Release Form-Scholarships