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 understand that I (the student) am ultimately responsible for any balance due to Gordon College. I further understand that my academic records and future registration are subject to a financial hold should I have an unpaid balance due to Gordon College.

If my student account becomes delinquent after separating from the College (www.gordon.edu/noncurrent), my account is subject to a monthly interest rate of 1.25% and may be placed into collections with an outside agency or litigation, at which point I will be responsible for all collection and/or legal fees incurred in securing the funds.

I understand that electronic notices may be sent to my alternate and/or billing emails as listed above and are considered official written communications from the SFS office.

I understand that I am responsible for updating the SFS office of any demographic (name/address/email/bill payor) changes.

I consent to have my financial aid and student account information released only to the name(s) I have listed above (Permission to Release Information).

If I have a credit balance on my student account, I authorize Gordon College to hold that credit until I request a refund (www.gordon.edu/refundrequest). {optional}

If I am eligible to receive an IRS Form 1098-T, I understand that it will only be available electronically (www.gordon.edu/1098t). {optional}

I affirm that, as of April 19, 2024, all of the reported information is valid and complete & that I have read and agree to the above checked Terms & Conditions.

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Signature Certificate

Document name: 2019-2020 Billing Contract

Unique Document ID: a76bfe860c760e2ad2ab7778e0ad1e01333046f6

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Timestamp	Audit
March 11, 2019 2:44 pm EDT	2019-2020 Billing Contract Uploaded by Gordon SFS - [email protected] IP 10.10.44.51

This audit trail report provides a detailed record of the online activity and events recorded for this document.

https://sign.gordon.edu/

Audit Trail Serial# 4a003978643f1b429e0dc1fb27576d4c