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Title IV Funds Authorization

Title IV funds are financial aid which include: Federal Direct loans (Subsidized, Unsubsidized, and Grad PLUS), Perkins, and work-study programs.

Federal Regulations require that Title IV funds be automatically applied to allowable fees such as tuition, room  and board, and mandatory fees. However, the institution must obtain your written authorization to apply your Title IV financial aid to all other charges appearing on your student account such as parking permit or tickets, health insurance charges, and other miscellaneous charges.

This voluntary authorization form is valid from the date of signing throughout the student鈥檚 entire academic career at 黑洞社区 of Medicine. You may revise your authorization by re-submitting this form or cancel the authorization at any time.

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CURRENT YEAR CHARGES AUTHORIZATION

If there excess Title IV funds in your student account after all allowable fees have been paid, you may give the institution consent to utilize these funds for all other charges during the current academic year.

Yes, I authorize the institution to apply my excess Title IV financial aid to all other charges appearing in my student account for the academic year.No, I do not authorize the institution to apply my excess Title IV financial aid to all other charges appearing in my student account for the academic year.

CREDIT BALANCE AUTHORIZATION

If the Title IV funds exceed all charges after they have been applied to your student account, you will be eligible for a refund (which will be mailed to your local address unless you have signed up for direct deposit). If you do not authorize the institution to apply your financial aid funds to prior charges, a refund will automatically be issued.

Yes, I authorize the institution to hold my excess Title IV financial aid in order to apply to any prior charges up to $200.00 appearing on my student account.No, please refund any credit balance remaining on my account after available funds have been applied to all other current year charges.

CANCEL AUTHORIZATION

Cancel Authorization

I would like to cancel any previous authorization given to the institution to utilize any excess Title IV fund credit balances on my student account to: (1) apply to all other charges and (2) hold for prior charges up to $200.00.

*Student's Name

*Signature Date

*Email

Submit  Cancel