Financial Aid Authorization 2021-2022 Return
this Completed Form to Student Financial Services
About You
Student’s Full Name:_____________________________________ Student ID:________________
Permanent Address: _____________________________________ City:_____________________
State:____________ Zip:___________ Telephone Number: ___________________________
Program of Study: Traditional Undergraduate Accelerated Degree Program Graduate
Federal Loan Confirmation: This request can be changed at any time, but it is not retroactive. Award amounts
are listed on the Shopping Sheet from Bloomfield College or online on the MyBloomfield Portal.
[ ] I accept Federal Direct Student Loans to the extent I am eligible for the 2021-2022 academic year.
[ ] I decline Federal Direct Student Loans for the 2021 -2022 academic year.
[ ] I do not wish to borrow the full amount I am eligible for. I would like to only borrow:
Subsidized Loan Amount $___________/yr Unsubsidized Loan Amount $___________/yr
_______________________________ ___________________
Student Signature Date Signed
THIS FORM MUST BE COMPLETED WITH A HAND WRITTEN SIGNATURE. ELECTRONIC
SIGNATURES ARE NOT ACCEPTED.
I understand that if I receive a full scholarship (from Bloomfield College or Outside Sponsorships)
I will be limited to direct costs, and my Bloomfield Award(s) will be reduced and/or eliminated,
by any state, federal, or outside gift and need based aid I receive.
___________________
Student Initials
For Office Use ONLY:
Tracked VStat Grants/Loans Adj Loan Docs 3 Sigs
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Communication Policy
Initial communications with new students will be by mail until the first day of class. Student
Financial Services will send any official communications (i.e. shopping sheets notifications and or
changes, requests for missing documents) via Bloomfield College Student Email exclusively.
Statement on Overpayment & Defaults
I understand that I may not receive any Federal Title IV Student Aid (Federal Direct Student Loans,
grants, etc.), or State funds if I owe an overpayment on any Federal Title IV grants.
I understand that I may not receive any Federal Title IV Student Aid (Federal Direct Student Loans,
grants, etc.), or State funds if I am in default on a Federal Title IV loan. With proof of rehabilitation I
may regain my eligibility for Federal Title IV aid.
Financial Acknowledgement
I understand that my Financial Aid Awards may have different renewal criteria, and I have
reviewed them from the current course catalog.
I understand that registration at Bloomfield College involves a financial obligation and promise to
pay Bloomfield College all amounts owed on my student account. I understand that if I receive
financial grants or monies that do not cover the full tuition costs, or if I withdraw from or drop
classes, I am responsible for the remaining balance due. I consent to Bloomfield College the use
of the following: written, electronic or verbal means to contact me as the law allows, including,
but not limited to, contact by manual calling methods, prerecorded messages, emails and/or
automated telephone dialing systems. I understand if I fail to pay my account, my account may be
placed with a collection agency and I will be responsible for any additional collection or attorney
fees.
____________________________________________ _______________________
Student Signature Date Signed
DO NOT PRINT. THIS FORM MUST BE SIGNED WITH A HAND WRITTEN SIGNATURE
Helpful Links
MyBloomfield Portal: You can access your Award Letter, Missing Information Requests, and
Billing Statements. https://Mybloomfield.bloomfield.edu
Direct Loan Links: Direct Student Loan MPN, Entrance Counseling, and Parent PLUS Loan MPN
www.studentloans.gov
Student Financial Services | finanical_services@bloomfield.edu | www.bloomfield.edu
467 Franklin Street | Bloomfield, NJ 07003 | (T) 973-748-9000 ext. 1212 | (F) 973-748-9735
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