Office of the Bursar
Title IV Authorization

Title IV Authorization Release for Non-Institutional Charges

This form may be printed and taken to the Cashier's Office for a Bookstore Card or to notify WSU that you would like your finanicial aid to pay for non-institutional charges. Download Form

Federal student financial aid can only cover “institutional charges” as defined by the U.S. Department of Education. This definition includes current year charges for tuition and fees, and on-campus room and board. It also includes other fees, such as: lab fees, workshops, university registration fees, facilities usage fees, and other specialized departmental or college fees associated directly with taking a class.

[ ]    Payment for previous semester charges (up to $200 Maximum)

[ ]    Hold funds for future semester charges

[ ]   Payment for other non-institutional charges, (i.e. Rental fees, library fees, parking fees, applicationfees, late fees, breakage fees, etc)

[ ]    Bookstore Card/Cash Advance Card

I hereby request a Weber State University Financial Aid/Bookstore Cash Advance Card(s) in the Amount of $______________ as an advance of my Financial Aid residual funds. I authorize Weber State University to use my Title IV Financial Aid funds as an advance to my residual fundsthat I expect to receive from my financial aid award for this Card(s). It is my responsibility to pay Weber State University for this card(s) if I withdraw from school before my financial aid is disbursed or if my financial aid award is insufficient to cover the balance on this card. It is my responsibility to report lost or stolen cards to the WSU Bookstore. Weber State University is not responsible for lost or stolen cards.

Card #(s)_________________________________________________________________

I hereby authorize Weber State University to apply my federal student financial aid to any non-institutional charges on my student account. I further understand that this authorization will remain in effect until I submit a written request to cancel this authorization.

Student Name_______________________________________ W________________________________

Student Signature: ___________________________________________ Date_______________

Cashier Signature: ___________________________________________ Date_______________


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