F Drive: FA Forms/General FA Docs/Title IV Authorization Form
Sequoias Community College District
Financial Aid Office
Visalia, Hanford, Tulare TITLE IV AUTHORIZATION FORM
Student’s Name _________________________________________________________________________
Banner ID Number or SS# _______________________ Date of Birth ______________________________
Authorization to Apply Federal Financial Aid to Current Year Non-Institutional Charges
Federal regulations allow College of the Sequoias to apply your Title IV Federal Student Aid payments (Pell Grant,
FSEOG, and Direct Loans) to institutional charges such as enrollment fees, student representative fee, student center
fee, health fee, activity/benefit fee, student transit fee, non-resident tuition fees, and material fees for the current year. The
College must obtain student authorization to pay non-institutional charges such as library charges, returned check
charges, short term loans, etc.
With your written authorization, this form will allow Student Accounts Receivable to apply your Federal Financial Aid to
your non-institutional charges.
Please check one box below: T4CY
I DO authorize College of the Sequoias to apply my Federal Financial Aid to any non-institutional charges on my
student account. I understand this authorization will take effect from the date this form is received and will remain in effect
for the entire period I am enrolled. This authorization may be cancelled at any time by notifying the Financial Aid Office in
writing, however, your cancellation will not be retroactive.
I DO NOT authorize College of the Sequoias to apply my Federal Financial Aid payments to any non-institutional
charges on my student account. I understand that I will be responsible for paying any outstanding debts to College of the
Sequoias.
Student Signature _______________________________________________ Date _______________________
Authorization to Apply Federal Financial Aid to Prior-Year Non-Institutional Charges
Federal regulations allow College of the Sequoias to apply up to $200 of your Title IV Federal Financial Aid payments
toward prior-year institutional charges. The College must obtain student authorization to pay prior-year non-
institutional charges.
With your written authorization, this form will allow Student Accounts Receivable to apply your Federal Financial Aid to
your prior-year non-institutional charges.
Please check one box below: T4PY
I DO authorize College of the Sequoias to apply my Federal Financial Aid to any prior-year non-institutional charges
on my student account. I understand this authorization will take effect from the date this form is received and will remain
in effect for the entire period I am enrolled. This authorization may be cancelled at any time by notifying the Financial Aid
Office in writing, however, your cancellation will not be retroactive.
I DO NOT authorize College of the Sequoias to apply my Federal Financial Aid payments to any prior-year non-
institutional charges on my student account. I understand that I will be responsible for paying any outstanding debts to
College of the Sequoias.
Student Signature ________________________________________________ Date __________________________
