Pacific University
Student Account Authorization Form
I Authorize Pacific University to charge my student account and use financial aid funds which can
include IV loans, grants, scholarships, or other institutional, federal, or state funds to pay any nonstandard charges assessed to my student account. These charges may include, but are not
limited to the following: assessment tool and equipment check outs.
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Student Name
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Student ID #
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Signature
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Date
Provided by the Society for Human Resource Management.
This is a sample template. Please consult with your legal counsel before adopting any new policy.