Federal Title IV Authorization Form
Federal Title IV Authorization Form
Under Federal law, SUNY Orange must receive your authorization to use your Title IV Federal student aid (Pell Grant, SEOG and Direct Loans) to cover any charges to your account other than Tuition and Fees. This authorization is valid for your entire enrollment period at SUNY Orange.
Student ID Number (A#)
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Must be
9
characters.
Currently Entered:
0
characters.
Name
Name
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First
Last
Please read the authorizations below, and put a check next to any authorization you would like to give.
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Please read the authorizations below, and put a check next to any authorization you would like to give.
PRIOR YEAR CHARGE AUTHORIZATION
- I authorize SUNY Orange to apply my Title IV Federal student aid to pay any outstanding prior year non-institutional charges up to the Federal limit of $200.
NON-INSTITUTIONAL CHARGE AUTHORIZATION
- I authorize SUNY Orange to apply my Title IV Federal student aid to pay any non-institutional charges. These charges include: (Bookstore charges, Late fees, Re-admit fees, parking fines, etc.)
APPLY CREDIT BALANCE TO FUTURE TERM
- I authorize SUNY Orange to apply my Title IV Federal student aid to pay future semester tuition and fee charges. (*Note: this will only be done if the future charges are already billed to your account when the credit balance occurs. Otherwise a refund will be processed.)
The student has the right to modify or cancel the above authorization at any time by submitting a withdrawal of consent in writing to the Student Services Central Office. Any modifications will become effective as of the date the form is received by SUNY Orange. If you choose not to give SUNY Orange authorization, you would have to pay any outstanding charges out of pocket.
Please type your electronic signature below:
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Please type the date you are electronically providing authorization:
Please type the date you are electronically providing authorization:
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