Student Business Services
Sage Hall
Phone: (805) 437-8810 Parent Plus Loan Direct Deposit
Fax: (805) 437-8900
CSUCI Parent Plus Loan Direct Deposit Updated 9/21/2016
Purpose: Intended for parents receiving parent plus loans who wish to receive disbursement via direct deposit.
INSTRUCTIONS FOR COMPLETION OF THIS FORM
• Read the Terms of Agreement & Authorization below.
• Fully complete the form. Print, sign and date the form.
• Attach one of your pre-printed checks to the form. Write “VOID” across the face of the check.
• Submit the original completed form (sorry, we cannot accept a fax copy of this form), including the terms
section to:
CSUCI Student Business Services
One University Drive
Camarillo, CA 93012-8599
TERMS OF AGREEMENT
• I understand that I am responsible for verifying with my bank that my account has been credited.
• I understand that expenditures made from my account without such verification are made at my own risk.
• I agree to promptly notify CSUCI of changes in my address or checking account status.
• I authorize California State University Channel Islands, and in accordance with the rules and regulations of
the National Automated Clearinghouse Association (NACHA), to credit any reimbursements due to me via
Automated Clearinghouse Electronic Fund transfer (ACH) to the bank and bank account owned by me and
referenced below. By this declaration I also authorize California State University Channel Islands to
withdraw funds from the above referenced bank account owned by me via ACH debit. Such debits are
authorized only to perform legitimate and appropriate financial transactions between me and California
State University, including but not limited to retrieval of reimbursement overpayments.
• This authorization will remain in effect until I withdraw from direct deposit. Any changes to the bank
account information below will require me to re-enroll in direct deposit.
• I understand that it takes up to 2 business days for the funds to become available following an ACH
electronic funds transfer, and incorrect bank information may delay my refund up to 14 days.
• I understand that if my loan disburses after an out-of-pocket payment has been applied to my student’s
account, the out-of-pocket payment will be reimbursed before any refund is calculated and sent.
AUTHORIZATION
Parent Name: ______________________________ Parent Date of Birth: ________________
Student Name: _____________________________ CSUCI Student ID: __________________
Parent Email Address: _________________________________________________________
Financial Institution: _________________________ Checking Savings
Bank Routing Number: ______________________ Bank Account Number: _____________
Parent Signature: _________________________________ Date: _____________________
ATTACH VOIDED,
PRE-PRINTED
CHECK HERE
click to sign
signature
click to edit
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