#_________ (Official Use Only)
Clarion University of Pennsylvania
Book Voucher Authorization
This request can only be used prior to your refund disbursement.
Student’s Full Name:___________________________________ Student ID:________________________
E-mail Address:_______________________________________ Cell Phone:________________________
Mailing Address:______________________________________________________________________________
I, _______________________________________, authorize Clarion University of Pennsylvania, the amount that is
advanced to and endorsed below to be used to cover institutional charges (e.g. required books and supplies). I understand
that these funds are from my anticip
ated financial aid refund and are required to be used at the Clarion University
Bookstore.
Student Signature___________________________________________ Date: ______________________
YOU ARE RECEIVING A VOUCHER THAT MUST BE REPAID
I further understand and agree:
1. If I decide to withdraw from Clarion University, I will be responsible for all
charges.
2. I understand I am responsible for my charges if my financial aid is reduced or canceled due to a change in my
enrollment status or eligibility and does not cover the amount I have charged.
3. The voucher will be automatically paid from any federal, state, institutional, or private financial aid proceeds
if they are available after the voucher is posted to the student’s university account.
4. The voucher shall be non-interest bearing.
5. Repayment can be made by the following methods:
Online - E-check, Debit Card, Credit Card (There is a fee for credit card payments.)
Parent/Guest Online Payments - Parents and guests must first be authorized by students to use the above
mentioned online payment options.
Payments By Mail - Check payments may be mailed to: Clarion University, Student Financial Services, 840
Wood St., Clarion, PA 16214
Payments In the Office - Cash, check, or debit card payments can be made in person in the Student
Financial Services office located on the first floor of Becht Hall. Credit card payments cannot be made in the
office.
6. Unpaid voucher balances are subject to university late fee and registration hold procedures.
7. Students with delinquent voucher accounts will not be permitted to register for courses, and academic
records (transcripts and diplomas) will be withheld until the voucher has been repaid.
Any questions, please contact Student Financial Services at 1-800-672-7171 option 2
Clarion University is an affirmative action equal opportunity employer.
For Bookstore Use Only
IT Report Date: ______________________________________ Initials:__________________
Needs reviewed by Student Financial Services Date: ____________________________
For Student Financial Services Use Only
Pending Aid $____________Charges $_______________ Voucher Amount $____________________
Date
______________
Approval Signature/FA staff
__________________
___________
Online Students: Once completed, email form and I.D. to the Clarion University Bookstore at LHenry@clarion.edu
click to sign
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