CREDIT BALANCE AUTHORIZATION FORM
Title IV funds are federal student aid funds which include, but are not limited to, Federal Pell Grants, Federal
Supplemental Educational Opportunity Grants (SEOG), Direct Loans and PLUS Loans. These funds are
automatically applied toward allowable charges on your school bill such as tuition and mandatory fees. If your
financial aid exceeds your allowable charges, federal regulations require that LCCC obtain authorization to pay
for “non-allowable charges” such as charges related to a prior semester, fines, etc. This form is used to
authorize federal student aid to pay for all institutional expenses.
Authorization (please check each box you agree with)
I understand this authorization is voluntary and that I can cancel it at any time.
I authorize LCCC to retain all excess funds, including Title IV aid, to pay for any charges assessed to my
student account.
I agree that this authorization is valid from the date of signing until I submit in writing the same form
stating I want my authorization to stop.
Cancellation of this authorization is not retroactive.
If my Title IV funds exceed all charges after they have been applied to my student account, I may be
eligible for a refund of these monies.
Check this box only if you’re cancelling a previous Credit Balance Authorization.
Student’s Name: Student ID:
Student’s Signature: Date:
Business Office Lehigh Carbon Community College
4525 Education Park Drive, Schnecksville, PA 18078
Office hours: Monday-Thursday, 8 a.m.-6 p.m.; Friday, 8 a.m.-5 p.m.
Phone: 610-799-1157 Fax: 610-799-1641 bursar1@mymail.lccc.edu
PERM3-hh (AC)
