Student Name___________________________________ Student ID # _____________________
What is the Title IV Authorization?
UVM is required by the Federal Government to receive permission from recipients of federal student aid funds
(PELL or SEOG grants, Federal Direct loans) on how to apply funds exceeding allowable charges (tuition,
mandatory fees, housing and meals).
Even if you agree to grant permission, the Department of Education does not allow federal student aid to pay
for late or penalty fees such as, late fees, returned check fees, or conduct fines (with the exception of library or
parking fines).
Please indicate your decision below:
I AGREE to give UVM permission to apply federal student aid funds to pay all permissible
outstanding, current year charges on my student account (including health insurance premiums) and/or
permission to apply my federal funds to cover up to $200 of prior year allowable charges.
I DISAGREE and only give UVM permission to apply my federal funds to allowable charges for the
current year.
Note: By selecting this option, it may mean that you receive a financial aid refund, but still owe money
to UVM. Failing to pay your student account may result in a financial hold preventing access to
registration, grades, transcripts, and possible disenrollment.
Your decision can be changed at any time by submitting a new Title IV Student Authorization form to Student
Financial Services.
Student Signature
Daytime Phone
Office of Student Financial Services
223 Waterman Building
Burlington, VT 05405
f: (802) 656-4076 | e: sfs@uvm.edu