FinancialNeedAnalysis (FNA) Form

Academic Year 2017-2018

Deadline: June 1, 2017

Part1.Tobecompletedbystudentandforwardedtoauniversityfinancialaidoffice.Pleasereadallinstructionscarefully.

SSN: ______Name: ______Student ID#______

Address: ______Phone: (______)______

“I understand I must submit the Free Application for Federal Student Aid (FAFSA) and apply for campus-based aid. I agree to do so no later than June 1st, 2017. I am responsible for contacting NHI prior to June 1st, 2017 for the AY 2017-2018 to confirm that this form has been received. If I DO NOT comply with the NHI Criteria, I understand my application will be denied”. Release of Information: I authorize the institution represented below to provide any/all information requested to NHI in order to evaluate my student financial need (including revisions) throughout the academic period covered in this application.

Applicant’sSignature:______Date:______

Indicatetheacademicperiodforwhichyouwantthecollegefinancialaidofficetoprovidebudgetinformation.□AY 2017‐2018(Sept.‐May/9monthperiodONLY)or□2017‐2018 PartialYearspecify terms:□Fall□Winter□Spring

PART 2. FINANCIAL AID OFFICE: Complete Part 2 for the period checked above. The final deadline for this form to be in NHI’s office is June 1st, 2017 for the AY 2017-2018 with no late exceptions. Faxed FNFs can be accepted, but please follow-up by mailing original. Please estimate cost & resources if the student file is not complete by NHI’s deadline. We cannot consider the student’s application until NHI receives this completed form.

BudgetPeriod:Checkonlyone. AcademicTermofStudent’sProgram:

□AcademicYear:Aug/Sept2017–May20178 Pleasecheckone:□Semester□Quarter

□2017‐2018 PartialYear,Specify:□Fall□Winter□Spring

Cost of Attendance: Campus-Based Aid and Other Resources:

Tuition $______Perkins $______Student Contribution ______

Fees ______Stafford ______Indian Health Service ______

Book & Supplies ______Work Study ______Dept. of Education ______

Room & Board ______Scholarship ______Assistantship ______

Personal/Misc ______School Grant ______Pell Grant ______

Transportation ______Tuition Waiver ______SEOG ______

Tribal Assistance ______Other: ______

TOTAL COST: $______TOTAL RESOURCES: $______

UNMET NEED: $ ______

The following question must be answered:

Has student submitted Free Application for Federal Student Aid (FAFSA) and campus-based aid application?______

Comments:______

University:______FAOPrintName:______

Address:______Signature:______

City/State/Zip:______Title:______

FAOfficePhone:(______)______DateSignedFNF:______

Fax:(______)______Email:______

Mailoriginalto:NHI | Post Office Box 26374, Albuquerque, NM 87125

OR email: | Deadline:June 1st ,2017