Student Business Services
4700 Research Way
Lakeland, FL 33805
863-874-8406
Fax: 863-874-8495
sbs@floridapoly.edu
Book Voucher Request Form
Student Information
First Name: __________________________ Last Name: _____________________________
Student ID # U0000000___ ___ ___ ___
ID Card #: __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __
Phone Number: _______________________ Semester: _______________________________
Email Address: _____________________@floridapoly.edu
Amount Requested: _____________________ Approved: _____________________________
Denied: _______________________________
_____________________________________________________________________________
_____________________________________________________________________________
Student Authorization
I understand that this Book Voucher is valid only for the semester indicated.
I understand that this Book Voucher allows me to purchase books and supplies at the University
Bookstore, up to the amount indicated above, and the actual amount charged against this voucher
will be added to my semester bill.
I agree to allow the University to use my financial aid funds (including federal student aid) to pay
my Book Voucher charges.
I understand that, if for any reason, my financial aid is not applied to my student account, or if it
becomes insufficient to cover my semester balance, I am responsible for paying my Book Voucher
charges.
I understand that if I fail to pay all of my semester charges, including this Book Voucher, my
ability to register for classes will be restricted, and my transcript and/or diploma will be
withheld.
_____________________________________________________________________________
Signature: ________________________________________ Date: ______________________
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