Student Authorization to Hold Excess Funds:
Purdue University Global disburses federal Title IV funds to your student account in order to apply those funds to your tuition and fees. If the funds
received exceed your current charges, you may choose to have Purdue University Global hold those funds on your account to apply toward tuition
and/or applicable fee charges to help you budget your expenses within the academic year, or you may opt to have the credit balance released on
a term-by-term basis. You may authorize the credit balance to be sent to you (the student) or to the lender as a refund. Please refer to your nancial
aid award letter as a guide to your nancial planning.
You must complete, sign, and submit this form using the Fax Cover Sheet located in the Important Forms section of your My Account Page in PG
Campus. To ensure that your document is processed eciently, please be sure to carefully read and follow the instructions in the document.
Please select only one option below.
__ I authorize Purdue University Global to retain any Title IV funds on my account in excess of my current charges. This may be done to help me
budget these funds and make them available to pay unpaid tuition and/or applicable fee charges from the current academic year. I understand
that Purdue University Global will refund any remaining excess funds to the lender at the completion of any academic year, and that this
authorization will remain in eect until I submit a written request to rescind it.
__ I authorize Purdue University Global to retain any Title IV funds in excess of my current charges on my account. This may be done to help me
budget these funds and make them available to pay unpaid tuition and/or applicable fee charges from the current academic year. I understand
that Purdue University Global will deliver any remaining excess funds to the student at the completion of any academic year, and that this
authorization will remain in eect until I submit a written request to rescind it.
__ I do not authorize Purdue University Global to hold any credit balance to be applied to future charges. Please deliver any credit balance
remaining on my account to the student. I understand that I should speak to Purdue University Global nancial aid sta to discuss my
responsibilities for future terms.
By submitting this completed form you are also acknowledging:
• If I have unpaid educationally related charges from the previous academic year (tuition, fees, etc), up to $200 of my current year excess
funds may be used to pay o or reduce the prior year balance, as allowed by federal regulations.
• I am canceling any authorizations indicated on any previously submitted versions of this form; only authorizations indicated on this
current version of the form will be in eect.
• Unless otherwise indicated, the option selected on this form applies only to credit balances in which the student is the borrower.
• To cancel or modify any information on this form I must do so in writing to the Financial Aid Oce.
• If I have questions about this process or this form in general I should contact the Financial Aid Oce.
Student Signature: ________________________________________________________________ Date: ________________________________
Student Print Name: _______________________________________________________________ Student Number: ______________________
CBS STDNT WEB FORM (Rev 12/2019)
