TITLE IV STUDENT
AUTHORIZATION FORM
2019-2020
Student Name___________________________________ Student ID # 95___________________
Title IV Student Authorization
The Federal Government requires that UVM receive permission from the recipient of Federal Student Aid funds
(e.g. Pell or SEOG grants, Stafford, Perkins or PLUS loans) before applying those funds to charges other than
tuition, mandatory fees, room and board.
Examples of charges which cannot be paid with federal student aid without your authorization are health
insurance, library fines and parking fines.
If you do not grant UVM permission to apply federal funds to all outstanding, current year charges on your
account you may receive a refund check and still owe money to UVM. Failure to pay your student account in
full may result in a financial hold which may prevent future registration and release of academic transcripts.
You may change your decision at any time by submitting a new Title IV Student Authorization form to Student
Financial Services.
Please indicate your decision below:
☐ I DO grant UVM permission to apply Federal Student Aid funds to pay all outstanding, current year
charges on my student account.
☐ I DO NOT grant UVM permission to apply Federal Student Aid funds to pay all outstanding, current
year charges on my student account. I understand that I may receive a refund check and still owe
money to UVM and that an unpaid balance on my student account will result in a financial hold,
preventing registration and access to grades and transcripts.
UNIVERSITY OF VERMONT
Office of Student Financial Services
223 Waterman Building
Burlington, VT 05405
f: (802) 656-4076 | e: sfs@uvm.edu
