ADP Financial Aid
STUDENT REQUEST TO RETURN OR CANCEL FEDERAL FUNDS
Choose one of the following THREE options:
 RETURN OF FUNDS TO LENDER (Funds have been disbursed)**:
of my Stafford SUBSIDIZED loan for the:
I would like to return: $
Check one:
 1ST DISBURSEMENT
 2ND DISBURSEMENT
Total amount to return for current Academic Year: $____________
(whole dollar amount only)
I would like to return: $
of my Stafford UNSUBSIDIZED loan for the:
Check one:
 1ST DISBURSEMENT
 2ND DISBURSEMENT
Total amount to return for current Academic Year: $____________
(whole dollar amount only)
**Completed form must be received within 30 days of loan disbursement to be returned to the lender.
 CANCEL LOAN (Funds have not been disbursed):
I would like to cancel: $
of my Stafford SUBSIDIZED loan for the:
Check one:
 1ST DISBURSEMENT
 2ND DISBURSEMENT
Total amount to return for current Academic Year: $___________
(whole dollar amount only)
I would like to cancel: $
of my Stafford UNSUBSIDIZED loan for the:
Check one:
 1ST DISBURSEMENT
 2ND DISBURSEMENT
Total amount to return for current Academic Year: $___________
(whole dollar amount only)
 CANCEL ALL LOAN DISBURSEMENTS
 Please DO NOT request any Federal Loans on my behalf.
AUTHORIZATION
I authorize the Warner Pacific Financial Aid Office to perform the request above for the current academic year
only. I also understand that I must provide written consent if I elected to change this request and utilize
Federal Funds for the current academic year.
Student Signature
Date
Student Name (Printed)
SSN
Warner Pacific College, Adult Degree Program
2600 SE 98th Ave, Suite 200, Portland, OR 97266
503.517.1550 (p) 503.517.1347 (f)