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Title IV Authorization Form

The Title IV (4) Authorization form pertains to credit balances created by federal funding and how the credit may be used.

The Title IV (4) Authorization form is specific to the use of said credit balances towards charges that are not included in tuition, room and board. Charges that may be assessed to a student throughout their time at Ithaca College include, but are not limited to health center charges, library fines, parking fines, etc. These charges could be from a current semester (Section A), a previous semester (Section B), or future semester (Section C).

The student would select "Yes" or "No" for each section, which indicates that credit balances created by federal funding can or cannot be used for these types of charges.  The form pertains to the term of the student's undergraduate and/or graduate studies and completion is only required once..

Once the student has signed and dated the form, it may be uploaded through our secured uploading link below:

Secure Online Document Submission