Kentucky State University

400 East Main Street

Frankfort, KY 40601

Dear Student:

In general, Federal Student Aid funds are allowed to pay only for educational expenses you incur in the period for which those funds are provided. However, Kentucky State University is permitted to use your Federal Student Aid to pay minor prior-year institutional charges if you have or will have a Federal Student Aid credit balance and we obtain your Authorization to pay the prior-year charges.

We may obtain authorization from you in advance to use Federal Student Aid funds to cover prior-year charges that are less than $100. To pay prior-year charges for amounts equal to or greater than $100, in addition to obtaining an authorization, we must determine that payment would not prevent you from paying for your current educational expenses. If you are a Federal Work-Study student, we may obtain permission from you for your earnings to be credited directly into your school account to pay your current educational expenses.

In order for the Bursar’s Office to deduct current and prior educational related expenses (i.e., health insurance charges, library fees, late registration, etc.) from a student’s Federal Student Aid, an authorization form must be provided to Kentucky State University. This authorization form is mandated by law. Therefore, for all students receiving federal funds, we must have this form on file prior to issuance of your refund.

If you do not wish to sign this authorization form, the refund process could result in a delay of your refund being issued. Not participating in the authorization program means that you will have to pay all other educational related expenses before we can issue your refund.

AUTHORIZATION

I,, identification number , authorize Kentucky State University’s Bursar’s Office to deduct educational related expenses in addition to my tuition and fees, if applicable, from my Federal Student Aid. I understand that if I wish to rescind this authorization, I must do so in writing to the Office of Financing and Collections (ASB Room 349).

I agree that above information is accurate.