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Name ______________________________________________________________

Social Security Number ___  ___  ___ -- ___  ___ -- ___  ___  ___  ___

Local Address _______________________________________________________

City State ZIP Code __________________________________________________

Term(s)     SU _____     FA _____      W _____      SP _____

Program ___________________________________________________________

Program costs will be deducted from the financial aid awarded. The remaining balance, if any, will be remitted by check, mailed to an address designated by the student and listed with the business office.

A Proof of Attendance form must be received prior to check disbursal.

By law, a Stafford loan must be endorsed or direct deposited in the student's bank account. If the WDW College Program student receives a Stafford loan of any type as part of the financial aid package, the student MUST leave deposit slips with the Business Office prior to departure.

According to federal regulations, Clark College is not able to disburse any financial aid prior to the start of each term. NOTE: There may be a variance between Clark College terms and those of the WDW College Program. The STUDENT must be prepared for those differences. In addition all students are responsible for any payments required in advance, such as application fees, deposits, program registration fees, plane tickets, etc.

I have read and understand the information and restrictions outlined. I authorize Clark College to apply my financial aid as indicated on my most recent Award Letter (not to include Stafford loans) to program costs.

I request that the Clark College Business Office deposit my Stafford Loan checks during the term(s) that I will be off campus for the WDW College Program:

In-state person authorized to act on my behalf regarding my financial aid in my absence:

Power of attorney given to this person? Yes ___________ No __________, if yes, please attach a copy.

Relationship to Student _______________________________________________

Address ___________________________________________________________

City State ZIP Code _________________________________________________

Phone ( ___ ___ ___ ) ___ ___ ___ -- ___ ___ ___ ___

Student Signature __________________________________________________

Date _____ / _____ / __________