SUMMER DEADLINE

JULY 1,2013

Choctaw Nation of Oklahoma

Department of Higher Education
P.O. Box 1210
Durant, OK 74702-1210
Toll Free (800)522-6170 or (580)924-8280
Fax (580)924-1267
Email: fnixon@choctawnation.com

Financial Needs Analysis (FNA)

PART I TO BE COMPLETED BY STUDENT
Students Full Name: _________________________________________________________ Maiden Name (if applicable)______________________
Mailing Address: _______________________________________________City___________________________State______Zip Code___________
Social Security No: ________________________________ Date of Birth:___________________ Telephone:________________________________

I grant permission to (name of school) _________________________________________ to release information stated below to the
Higher Education Program of the Choctaw Nation of Oklahoma. Student Signature: _______________________________________

PART II TO BE COMPLETED BY THE FINANCIAL AID OFFICER

*** FORM SHOULD BE COMPLETED FOR SUMMER 2013 ***
SCHOOL EXPENSES

STUDENT RESOURCES

AWARDS

Tuition
$_____________
Fees
_____________
Books
_____________
Supplies
_____________
Room & Board
_____________
Dependency Allowance _____________
Transportation
_____________
Personal Expenses
_____________
Loan Fees
____________
Other (List)
____________
____________

Family Contribution
$______________
Student Contribution
______________
Veterans Benefits
______________
Social Security
______________
Vocational Rehabilitation
______________
Fellowships
______________
IHS Grants
______________
State Indian Scholarship
______________
Other (List)
______________
______________
______________

PELL
$_____________
SEOG
____________
Work Study
____________
Perkins
____________
GSL/Stafford
____________
Unsub. Stafford
____________
Tuition Waiver
____________
State Tuition Grant
____________
University Scholarship
____________
Off Campus Scholarship ____________
Direct Loan
____________
OHLAP
____________
PLUS
___________
Other (List)
____________

Total Expenses

$______________

Total Resources

Classification: Fr____ Soph____ Jr____ Sr____ Grad ____

$______________

Part-Time____ Full-Time ____

Total Awards

$_____________

Unmet Need

$_____________

This student aid package is consistent in type and amount with packages prepared for students in similar circumstances who are not eligible for BIA
assistance. New vendors: The school name and address used below should be consistent with information provided when completing a W-9 form.
FINANCIAL AID OFFICER:

INSTITUTION:

Signature:___________________________________________

Name:___________________________________________________

Email:______________________________________________

Address:_________________________________________________

Date:_______________________________________________

________________________________________________________

Tax Identification Number (TIN):

Phone #:_________________________________________________

Fax #____________________________________________________