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{ > R , ~ $ $ l : TITLE IV AUTHORIZATION
INDIANA UNIVERSITY OF PENNSYLVANIA
Student Name___________________________________ Student ID_____________________
I hereby authorize ϳԹ 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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