Financial Aid Office • SUNY Plattsburgh • 101 Broad Street • Plattsburgh, NY 12901-2681
Tel: (518) 564-2072 • Toll-Free: (877) 768-5976 • Fax: (518) 564-4079 • email: finaid@plattsburgh.edu
Revised: 12/01/2019 ATPXX
AUTHORIZATION TO PAY HOST INSTITUTION
Student Name: ___________________________ Banner ID or NetID: ____________________________
Students complete this form if they are participating in a study abroad program, national student exchange, or
any other program or credits in which the student is attending a different university while maintaining
matriculation at SUNY Plattsburgh. This form provides SUNY Plattsburgh with legal authority to use your
financial aid to pay the other host institution, adjust your financial aid eligibility, and set up proper notification
with the host institution
INSTRUCTIONS
1. Follow the Registrar’s instructions for cross registration and off-campus study.
2. Submit the Cross Registration and Off-Campus Study Form to the Registrar.
3. Complete the four sections below: Host Institution, Authorization, Attachments, and Signature.
4. Attach all documentation and submit to the Financial Aid Office.
HOST INSTITUTION
For students remaining within the United States, the host institution is the college where you will enroll in courses. For
study abroad students enrolling in courses outside the United States, the host institution is the U.S. College whose
program you are studying through, not the college outside the U.S.
Name of Host Institution:
Address of Host Institution:
Semester at Host Institution:
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AUTHORIZATION
Check one of the boxes below to indicate your intent, if checking the first box you must fill in the amount:
☐ By signing below, I authorize SUNY Plattsburgh to use my financial aid refund to pay $________________ to the
host institution for the enrollment period. I also acknowledge that I am responsible for paying the entire bill at the
host institution if my refund does not cover the entire account balance or if the host requires payment prior to my
refund becoming available.
OR
☐ By signing below, I acknowledge that I have already or will pay the balance due at the host institution.
ATTACHMENTS
Attach the following documents:
• Proof of Cost: attach a copy of the bill for the courses you are enrolled at the host institution.
• Proof of Registration: attach a copy of your class schedule or registration confirmation at the host institution.
Students may submit Proof of Registration at a later date if it is not available at this time.
SIGNATURE
Student Ink Signature Date
