Award Declination Form

Complete this form only if you wish to decline all or a portion of the financial aid offered to you. If you do not return this form, we will assume that you accept your financial aid offer. See the Terms and Conditions of Financial Aid for information about the types of financial aid on your award letter. Please return with 14 days of receiving.

Entries marked with * are required.

Your Information

Name*:
NetID:
Email*:

Award Declination

Please choose*:

I will attend the Dartmouth Geisel School of Medicine. However, I wish to decline the financial aid offered to me.
I wish to decline a portion of the financial aid offered to me as follows:

New Amount Requested must be *less than* the amount offered. The new amount requested will be distributed proportionally across terms, based on your enrollment status, unless you provide other instructions.
Award 1
Award Name:	As listed on your award letter
Total Amount Offered:
New Amount Requested:	Enter $0 if applicable
Award 2
Award Name:	As listed on your award letter
Total Amount Offered:
New Amount Requested:	Enter $0 if applicable
Award 3
Award Name:	As listed on your award letter
Total Amount Offered:
New Amount Requested:	Enter $0 if applicable
Award 4
Award Name:	As listed on your award letter
Total Amount Offered:
New Amount Requested:	Enter $0 if applicable
Award 5
Award Name:	As listed on your award letter
Total Amount Offered:
New Amount Requested:	Enter $0 if applicable

Additional Information:

You may use this space to explain your request, if necessary.

Signature*:

Type your full name as your signature