Northwest State Community College • 22600 State Route 34 • Archbold • OH • 43502
Phone: 419-267-1333 • Fax 419-267-5587 • finaid@northweststate.edu
Have you attended or do you plan to attend any other college(s) between July 1, 2020 and June 30, 2021?
____Yes ____No
If yes, list the institution name, city and state below.
Federal student financial aid can only cover “institutional charges” as defined by the US Department of Education.
This definition includes current year charges for tuition and fees. Unless authorization is received, federal financial
aid cannot be used to cover non-institutional charges. (For example: books in the bookstore, educational supplies, lab
fees, and other student fees)
I authorize Northwest State Community College to apply federal student financial aid for any non-institutional
charges on your account.
I understand that this authorization will remain in effect until I submit a written request to cancel this authorization.
Please INITIAL one of the following:
Yes, I authorize ________ No, I do not authorize ________
Federal student financial aid can only cover the “current” academic year institutional charges. Current year charges
include Summer 2020, Fall 2020, and Spring 2021. To use the current academic year’s financial aid to pay for prior
year charges, you must provide written authorization. Federal regulations allow up to $200 of a prior year’s charges to
be paid by your current year’s financial aid.
I authorize Northwest State Community College to apply my federal student financial aid to pay up to $200 of
any prior year charges if applicable.
I understand that this authorization will remain in effect until I submit a written request to cancel this authorization.
Please INITIAL one of the following:
Yes, I authorize ________ No, I do not authorize ________
By signing this form, I certify that all the information reported to qualify for Federal and State student aid is complete and
correct. WARNING: IF you purposely give false or misleading information on this form, you may be subject to fines and/or
penalties.
Student Signature: _______________________________ Date: ______________________
Northwest State Community College does not discriminate on the basis of race, color, national origin, sex, gender identity, disability, religion or age
in its programs or activities.
Other College/University Attendance
Authorization Release of Non-Institutional Charges
Authorization to Apply Federal Financial Aid to Prior-Year Charges
