Direct Deposit Authorization for Financial Aid Refunds
(Please print clearly)
Complete Name:
Last four #s of SSN:
To complete the account information below, use the following information:
For Direct Deposit through Checking
Use information found on your check:
Note: You can also find your account number on your statement or on
your account documents provided at account opening. Do not include
the check number when providing the required information below.
For Direct Deposit into Savings
For your savings account number, check your bank
statement or account documents provided at
account opening.
Contact your bank for correct routing number.
Bank Name:
Name on Account
(if different from above):
Checking Account Savings Account
I hereby authorize The Chicago School, to initiate credit entries to the savings or checking account indicated above for any excess funds from my
financial aid after tuition and fees are paid. This authorization shall remain in full force and effect until The Chicago School has received written
notification from me of its termination in such time and in such manner as to afford The Chicago School a reasonable opportunity to act on it. Future
refunds will be direct-deposited into this account.
I understand and agree that if at some point my account information changes, The Chicago School must be notified IMMEDIATELY. This agreement
may be cancelled at any time, but must be done so in writing. This agreement will continue every term unless or until I or my bank notifies The Chicago
School in writing that the account information has changed or upon the end or interruption of my student affiliation with The Chicago School.
____________________________________ _____________________________
Student Signature Date
Please submit this form to:
The Chicago School of Professional Psychology
Office of Student Accounts
Fax: 312.488.6336
| Email:
ABA/Routing Number
Account Number
click to sign
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