Cashier
to Grinnell College Frontdoor  

    The Billing Authorization Form is required by federal law to be on file for each student. Federal law prevents the cashier from releasing any student account information to anyone other than the student unless they are listed as being authorized on the Billing Authorization Form. In addition, this form provides important information regarding the financial responsibilities of the student. Any questions concerning this form should be directed to the Office of the Cashier.

Billing Authorization Form
(Please check correct box)
Initial Notification
Change Request

    I promise to pay Grinnell College the sum of the amounts incurred by me on my student account. I understand the charges and any applicable financial aid amounts are subject to adjustments that may change the balance due. Grinnell College will provide notification of any changes. If the payments become delinquent, my registration, board, and housing privileges may be cancelled. Readmittance will be permitted only upon receipt of past due balances. I understand a late payment fee of 1.5% per month of the outstanding balance will be assessed on delinquent accounts and that Grinnell College reserves the right to recover all costs involved with the collection and/or litigation of delinquent accounts.
    I consent to and further knowingly provide my cellular or other telephone number and any subsequent change in contact numbers or other means of communication, including but not limited to, electronic mail at the address provided by me, to Grinnell College as a means for Grinnell College, or any debt collection agency or attorney hired by Grinnell College, to contact me directly or through automated or predictive dialing system or prerecorded messaging system in an effort to recover any unpaid portion of my obligation incurred hereunder, or as otherwise determined in the event of my default to any obligations identified herein.

1) Federal Title IV financial aid funds are restricted to payment of current academic year tuition, fees, room, and board. Students may authorize use of these funds for prior academic year expenses not to exceed $200. Please indicate your choice below:
I authorize Grinnell College to use federal funds/aid for prior year charges up to $200.
I do not authorize Grinnell College to use federal funds/aid for prior year charges.

2) If the amount of my Title IV financial aid exceeds the charges for tuition, fees, room, and board, I authorize Grinnell College to:
Apply the excess to my student account and retain a credit balance on the account unless I request the funds.
Refund the credit to me by direct deposit to my personal account. (Forms available online at http://www.grinnell.edu/sites/default/files/documents/DirectDepositStudent_0.pdf)

3) I authorize the Office of the Cashier to provide my student account information to the following parties:
I do not authorize anyone to talk to the Grinnell College Office of the Cashier about my account.
I authorize the Grinnell College Cashier to provide my student account information to the following parties:
Mother
Father
Other (Please list name(s) below.)
    [1] Relationship     Name
    Address     City, State, Zip
    [2] Relationship     Name
    Address     City, State, Zip

4) Please mail the first billing statement of each semester to me at my:
Home Address
Campus Address
Noncustodial Parent
Provide Noncustodial Parent Name, Address, City, State, Zip:


I understand that I may change the above authorization at any time by completing a new form available at the Office of the Cashier or online at https://itwebforms.grinnell.edu/apps/cashier/authorization.htm. If I have any questions on any of the above, I understand I should contact the cashier.

Student's Name     Telephone
To verify, please enter your Student Account Number: