_____ Fall Semester    ____ Spring Semester

Date of request: ______________________   Phone: ____________________________

Name: __________________________________________ SSN: __________________

Employee Status:        _____full-time                         _____ part-time

                       Purpose:________________________________________________________________

_______________________________________________________________________

Course Number/Name: _______________________________Credit Hours: _________

Amount requested for :
Tuition ____________
Books ____________
Tuition fees ____________
Baccalaureate fees ____________
Other fees ____________

                                                                        TOTAL COST _________

Spring Semester: December 1

Fall Semester: July 1

Summer Semester (if funds are available): May 1

WVU Parkersburg Staff Council encourages employees to donate money from the sale of their books back to the WVU at Parkersburg Foundation Employee Scholarship Fund to provide additional funds for staff in the future. 

Financial Aid Office Use Only:
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