Federal Work Study Program

Termination Form

    Student Name   __________________________                         Social Security Number  ______________________

    Department       __________________________                         FWS Account Number  _______________________

    Contact Person __________________________                         Contact Email Address   _______________________

    Termination Date ____________ ( MM/DD/YY)

  Reason for termination:

___End of Fiscal Year        ___Student Transferred        ___Award Amount Fully Earned        ___Award Cancelled

___Other (Please enter reason below)

          ________________________________________________________________________________________________________________________________

________________________________________________________________________________________________________________________________

Authorized by:

_________________________            _____________                     _______________________

Project Leader/Dept. Supervisor             Title                                       Telephone

__________________________                                                     __________________           

Project Leader Signature                                                                    Date

Attention: Please print this form and forward a copy to payroll, financial aid, student, and hiring department.