North Carolina A&T State University
Title IV Authorization Release
Non-Institutional Charges and Prior Year Charges Form
Name: Banner ID: xxx_______________
Last First MI
Federal regulations require NC A&T State University (NC A&T) to apply Title IV funds (Federal Pell
Grant, Federal SEOG, Federal TEACH Grant, Federal Direct Loans, Federal Direct Graduate and PLUS
Loans) to qualifying educational “institutional charges” as defined by the U.S. Department of Education
such as current tuition, fees, and room and board charged to the student’s account. It also includes other
fees such as lab fees, workshops, university registration fees, facilities usage fees, and other specialized
departmental or college fees associated directly with taking a class.
Unless authorization is received, federal financial aid cannot be used to cover non-institutional charges
such as: bookstore charges, housing damages, parking fines, library fines, breakage fees, returned check
fees, insurance, medical charges, late registration fee or any charges not directly tied to taking a class.
You may authorize the University to apply excess Title IV funds to cover these charges. You may also
authorize the University to use excess Title IV funds to help cover up to $200 of prior year charges.
Authorization 1 - Current Term Charges
____Yes, I authorize NC A&T to apply my Title IV funds to ALL outstanding charges on my
student account. After all charges are paid, I will receive a refund of the excess (if applicable).
____No, I do not authorize NC A&T to apply my Title IV funds to outstanding charges. (I
understand that I will be responsible for the payment of outstanding non-institutional charges
on my student account.
Authorization 2 - Prior Year Charges
____Yes, I authorize NC A&T to apply my federal financial aid to pay up to $200 of
my prior year charges after all current year charges are paid. (If you have a balance from a prior year and have
excess financial aid after your semester charges, you can use up to $200 from the current year to assist with clearing your student
____No, I do not authorize NC A&T to apply my federal financial aid to pay up to
$200 of my prior year charges. (You must pay all prior year balances in full which may prevent you from registering.)
I understand that my authorizations will remain in effect while I am enrolled at NC A&T State
University and that I may cancel or modify my authorizations at any time by completing a new Title IV
Student Signature: ________________________________ Date: _____________________
You may return this form by mail, email, fax, or in person:
North Carolina A&T State University,
1601 East Market Street
Greensboro, NC 27411
Fax #: 336-334-7208