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{ > R , ~ $ $ l : TITLE IV AUTHORIZATION
INDIANA UNIVERSITY OF PENNSYLVANIA
Student Name___________________________________ Student ID_____________________
I hereby authorize Ƶ to retain my Title IV financial aid to be applied to any non institutional charges of the same aid year (i.e. infirmary fees, library fines, damages) for as long as I attend this university. I understand I can rescind this authorization at any time prior to the application of the Title IV aid to my account. I also understand that this will not cover institutional charges from a prior aid year. This will in no way be a hardship to me.
__________________________________________ ____________________
Student Signature Date
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