Transcription of 1213 Title IV Authorization Form - University of …
1 Title A. STU Student E-mail A B. AUT Please se _____ _____ Student INSTRUF ederal and/or cpermissifor any cfederal NOTE: E IV AUTHUDENT INFOt Name: ____ Address: ___ THORIZAT elect an optio__ I volpay cacadMem__ I do educpay fmy ct Signature: _UCTIONS: regulations reurrent term nion, my federcharges that Taid until I paPlease checkHORIZATIORMATION_____(Please P_____ION on below: untarily authcurrent educdemic year. Imphis, and I mNOT authorcational charfor these chaclasses. _____equire authorinon-educationral aid will paTitle IV fundsay all chargek TigerXpressION AND N _____Print) _____horize The Ucational charI understandmay cancel trize The Univrges as well aarges myself _____ization from tnal charges wiay only enrollms and other fues owed to Ths through youPRIOR TE_____University of rges, non-edud this authorithis authorizaversity of Meas prior term before receiv_____the student toithin the samement fees andunds will not che Universityur myMemph ERM CHA____ ____ Memphis to ucational chaization will ration, in writemphis to crecharges withving any refu_____o use Title IV e academic yed dorm room cover.
2 I undey of Memphihis account to ARGES FOU ID NumbPhone: ____credit all Tiarges and priremain valid ting, at any tedit Title IV hin the sameunds and fail_____funds ( , feear ( Fall, charges. I acerstand I may s. determine yo Stu103 Wilder Web: wwwEmail:ORM ber: _____itle IV funds ior TERM chwhile enrolltime. funds to paye academic yelure to do so _ Date: ___ederal financiSpring, Summcknowledge thnot receive aour account budent FinancTower MempMain: : financialaid@_____to my studenharges withined at The Uny current nonear. I undersmay result i_____ial aid) to paymer). Withouhat I will be rany refunds falance. cial Aid Officphis, TN 38152: : account ton the same niversity of n-stand I will in deletion of_____ y prior term ut my responsible from e 2 5 0 d u o f
