Federal Funding Authorization

Federal Funding Authorization

University charges other than tuition, fees, room and board, cannot be paid automatically by

Federal Title IV funds without your express authorization. This includes charges such as parking,

health services or balances from previous semesters. Without a waiver, you must pay these

charges even if a refund check is received.

To avoid this inconvenience a waiver is available. This waiver authorizes the MICA Student

Account's Office to use Federal Title IV funds to pay any and all charges that may appear on

your bill.

Student Information

Legal First Name *

Preferred Name

Last Name *

ID # *

I authorize the Maryland Institute College of Art to use any federal funds I may receive (Federal Pell Grant, Federal SEOG, Federal Direct Loans or Federal Plus Loan) to cover any charges incurred during each academic year that are over and above tuition, fees, and room and meal plan charges. (Examples of such costs are: Book Store Accounts, Health Insurance, Parking Permits, Library Fines, etc.) Further, I authorize the Maryland Institute College of Art to use federal funds that may be in excess of current academic year charges to pay prior year balances not to exceed $200. This authorization will remain in effect while you are a student at MICA. It may be rescinded or changed by sending a written request to the Financial Aid Office. Any rescission of this authorization will not be retroactive.

Student Signature (use mouse to sign) *

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