ࡱ> |~{g ybjbj`` 8 x\ x\d VV8:VPMrrrrT$T$T$LLLLLLL$jO RLT$##|T$T$LVVrP M&&&T$vVrVlrL&T$L&&nFP, Ir0{b$jcG L M0PMG&S4%p&S@ I I8&SCIxT$T$&T$T$T$T$T$LL%pT$T$T$PMT$T$T$T$&ST$T$T$T$T$T$T$T$T$ > :  Revocation of eConsent of Use of Title IV Funds Form ______________________ ______________________ First Name Last Name ______________________ ______________________ Student/Gothic Id Number Email Address I, the above named student hereby withdraw my consent to pay certain charges, such as parking fees, book advances, fines, etc. on my student account with federal Title IV funds. The student understands that the charges no longer paid by Title IV funds need to be paid by the posted deadline in full or via an authorized payment arrangement. The student understands that unpaid charges may result in late payment fees or deregistration from their courses and/or removal from housing. This request for revoking the payment of certain fees with Title IV funds will be void if I later choose to pay these charges via this payment method. ________________________________________________________________________________________ Student Signature Date of Signature Please mail, email or fax this request to the contact information listed above. The Office of Student Accounts will process and accept your request to revoke the payment of certain charges with Title IV financial aid. The staff member responsible for the acceptance will return a signed copy of this form to you at your NJUC email address and will indicate the date the revoke of eConsent took effect. 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