2017-2018 Arizona Assurance Funding Appeal Form
Priority Deadline: July 1, 2017
Final Deadline: August 21, 2017*
*The Arizona Assurance Funding Appeal will be removed after August 21, 2017. If a student has an extenuating circumstance in which they wish to appeal, the student should submit the General Appeal form.
Reasons for Funding Appeal
Appeals are considered independently according to the circumstances of that request. Common examples of situations giving rise to a request for appeal include, but are not limited to:
- **Student’s own medical or physical illness or injury or disability –see process below
- Personal Reasons
- Family, including death of a family member
- Other extenuating circumstances that are beyond the student’s control
Requirements for Funding Appeals
If the reasons for submitting the funding appeal are other than the student’s own mental or physical illness or injury or disability:
Students appealing based on circumstances other than their own mental or physical illness or injury or disability must:
- Attach a personal statement explaining the circumstances of the request, which should be no longer than one page in length;
- Attach supporting documentation (e.g., letter from religious leader related to religious missions, letter of acceptance into non-UA-study abroad program, call to active duty, letter from attorney or other individual confirming circumstances beyond the student’s control, etc.).
- Complete the Arizona Assurance Funding Appeal form in its entirety
If the reasons for submitting the funding appeal relate to the student’s own mental or physical illness or injury or disability:
**Students submitting the funding appeal based on their own mental or physical illness or injury or disability must complete the Arizona Assurance Funding Appeal form in its entirety, include a basic personal statement and:
Obtain a letter from a licensed health care provider, on the health care provider's letterhead, which contains the following information:
- The approximate date of onset of the mental or physical illness or injury or disability giving rise to the circumstances surrounding the appeal, and the dates through which such condition is reasonably expected to continue;
- The general nature of the mental or physical illness or injury or disability that gave rise to the request for the appeal
- The date on which the student anticipates being able to resume his/her scholarship.
Provide your licensed health care professional's letter to Campus Health Service to the attention of:
Dr. Michael McDermott
P.O. Box 210095
Tucson, AZ 85721
Campus Health Service will review the letter and, if it meets the conditions for appeal based upon the student’s own mental or physical illness or injury or disability, it will issue a Verification of Health-Related Reasons for OSFA form. The Verification form will include the dates of onset of the condition and the dates through which such condition continued, but will not include information related to the nature of the condition.
The student must attach the Verification of Health-Related Reasons for OSFA to the student’s Arizona Assurance Funding Appeal form and return it along with a personal signed statement to OSFA.
The University reserves the right to modify this process at any time. Submission of an Arizona Assurance Funding Appeal does not guarantee approval.