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