Instructions: fill out form, choose ‘print’ icon then ‘save as pdf’ and email form from your device to financialaid@rpcc.edu
Title IV Authorization and Prior Term Charges Form
A. STUDENT INFORMATION
Student Name: _________________________________________ Student ID#: _________________________________________
Student Mailing Address: __________________________________ Telephone Number__________________________________
Email Address: _______________________________________________________________________________________________
B. AUTHORIZATION
(1) PRIOR TERM CHARGES AUTHORIZATION: Please choose one of the following by initialing
Federal Title IV financial aid funds are restricted to pay current period tuition and fees. Students may authorize use of these funds, i.e., Pell
Grant, SEOG, Direct Subsidized or Unsubsidized loans, for prior period expenses, not exceeding $200.00. To enable River Parishes Community
College will disburse any remaining credit balance on Title IV financial aids funds in this manner, please indicate your choice below. River
Parishes Community College will disburse any remaining credit balance on Title IV loan by the end of the loan period and any other remaining
federal student aid program funds by the end of the last payment period in the award year for which they were awarded.
______ I (accept) authorize River Parishes Community College to use Federal funds/aid for prior year charges.
______ I (decline) do not authorize River Parishes Community College to use Federal funds/aid for prior year charges.
(2) NON-INSTITUTIONAL CHARGES AUTHORIZATION: Please choose one of the following by initialing
River Parishes Community College uses a system of applying awards to the charges of eligible students. River Parishes Community College
automatically applies Title IV awards to tuition and fees. The student may authorize River Parishes Community College to apply Title IV
awards, i.e. Pell Grant, SEOG, Direct Subsidized or Unsubsidized loans for non-institutional charges incurred, such as books, and miscellaneous
fines (e.g. library fines, prior-year balances, etc.). If you are eligible for Federal financial aid in excess of tuition and fees and you wish to use
the excess to cover other charges, you must authorize River Parishes Community College to pay these charges. River Parishes Community
College will disburse any remaining credit balance on Title IV loan by the end of the loan period and any other remaining federal student aid
program funds by the end of the last payment period in the award year for which they were awarded.
______ I (accept) authorize River Parishes Community College to apply the credit balance derived from Federal funds, i.e. Pell Grant, Direct
Subsidized or Unsubsidized loans to charges to my student account for other non-institutional charges such as: books/supplies, library
fines etc.
______ I (decline) do not authorize River Parishes Community College to apply the credit balance derived from Federal funds, i.e. Pell Grant,
Direct Subsidized or Unsubsidized loans to charges to my student account for other non-institutional charges such as: books/supplies,
library fines etc.
I understand that I may revoke any individual item or all these authorizations at any time by submitting my request in
writing to the Financial Aid Office.
______ I understand that the Financial Aid Office communicates with me via email and I understand it is my responsibility to read my RPCC email
regularly as well as the email address that I provided on my FAFSA. I also understand that if I DO NOT wish to receive Financial Aid
communications and award notifications via email, I MUST submit a request in writing to the Financial Aid Office.
Signature: ________________________________________________ Date: ______________________________
This authorization will remain in effect for each subsequent payment period unless you withdraw it. This authorization may be withdrawn at any time by providing a
written request.
Office of Financial Aid & Scholarships
Gonzales-Westside-Reserve Campuses
Financialaid@rpcc.edu
