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Undergraduate Graduate

WORK-STUDY FUND REQUEST

DIRECTIONS Return this form


In person on campus:
333 Science Teaching & Student Services
Please print legibly and add your signature in blue or black ink. 130 West Bank Skyway
130 Coffey Hall
160 Williamson Hall
By mail to:
Office of Student Finance
20 Fraser Hall
106 Pleasant St. SE
Minneapolis, MN 55455

To ensure privacy online, open in Adobe Reader (free at Adobe.com). Please add the required signature(s) in blue or black ink.
SECTION A. Student information
Name (last, first, middle initial) Phone (include area code) University ID

Semester employment requested Half- or full-time enrollment Work-study amount requested

fall spring summer fall spring summer

Supervisor’s name (if currently employed on campus) University department Supervisor’s phone number

SECTION B. Certification
Decline/reduce my (give type of loan) loan from to
Student signature Date

LPU initials date counselor comments

osf staff name unmet need date

To request copies of this form in an alternative format, please call a Disability Resource Center
liaison at 612-625-9578. The University of Minnesota is an equal opportunity employer and
educator. This form is printed on paper made from no less than 20 percent post-consumer waste.
*FA608* FA608—Page 1 of 1 12/14
Please recycle.

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