2022-2023 Billing Contract


  2022-2023 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 July 6, 2022, all of the reported information is valid and complete & that I have read and agree to the above checked Terms & Conditions.

Leave this empty:

Signature arrow sign here


Signature Certificate
Document name: 2022-2023 Billing Contract
lock iconUnique Document ID: 651d009986f5504416b9620e0d095d2d42bbef69
Timestamp Audit
February 16, 2022 8:45 am EDT2022-2023 Billing Contract Uploaded by Gordon SFS - [email protected] IP 50.233.127.46