2019-2020 Billing Contract


  2019-2020 BILLING CONTRACT 

STUDENT INFORMATION

Student Name:  ,

Student ID #: Student’s Alternate Email: 


PERSON RESPONSIBLE FOR PAYMENT (BILLING ADDRESS)

Name:  Email: 

Address:  Phone #:   

,


PERMISSION TO RELEASE INFORMATION (FERPA)

The Family Education Rights and Privacy Act (FERPA) prohibits the Student Financial Services Office from disclosing the student’s information to any third parties without the student’s consent. In order for any information to be released to any third party, the student must provide written consent. To do so, the student must complete the section below. 

I hereby authorize the following person(s) listed below access to my personal information with regards to the financial aid process and my student account at Gordon College. I recognize that this only pertains to the Student Financial Services Office and not other departments on campus and that I have the right to rescind this request at any time.

Name:    Relationship: 

Name:    Relationship: 


SFS TERMS & CONDITIONS


I affirm that, as of February 24, 2020, all of the reported information is valid and complete & that I have read and agree to the above checked Terms & Conditions.

Student Signature:

Leave this empty:

Gordon College https://sign.gordon.edu
Signature Certificate
Document name: 2019-2020 Billing Contract
Unique Document ID: 512f78ebe00ffdc5999a0f0095a45b311eca864e
Timestamp Audit
March 11, 2019 2:44 pm EST2019-2020 Billing Contract Uploaded by Gordon SFS - Gordon.SFS@Gordon.edu IP 10.10.44.52