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If you select "No" to the second statement all other educationally -related charges as defined above <br />will be your responsibility. <br />3.) 1 authorize California Truck Driving Academy to hold any excess Title IV funds on my account <br />as a credit balance and to apply those funds and any Title IV funds to outstanding <br />educationally -related charges that have been charged to my student account by the College <br />for the prior award year not to exceed $ 200. <br />Yes ❑ No❑ <br />To allow California Truck Driving Academy to hold credit balances and apply excess Title IV funds to <br />apply to prior year educationally -related charges up to $200 you should select "Yes" to the third <br />statement. If you select "No" to the third statement any other educationally -related charges from the <br />prior year will be your responsibility. <br />Checking the "No" box or failing to return this form will have the following effect: <br />If you do not complete the Authorization Statements below, Title IV funds in excess of your current <br />charges will be refunded directly to you. All outstanding educationally -related and future tuition and <br />fee charges will remain your responsibility. <br />FEDERAL (TITLE IV) AUTHORIZATION STATEMENT <br />Your authorizations will remain in effect for the entire period that you are enrolled at California <br />Truck Driving Academy; however, these authorizations can be modified or cancelled at any time. To <br />modify or cancel these authorizations you must put your request in writing and forward it to the <br />California Truck Driving Academy Accounting Office at: 921 North Poinsettia Street, Unit A, Santa <br />Ana, CA 92701. Any modification or cancellation is effective on the date the California Truck Driving <br />Academy Accounting Office receives the notice of modification or cancellation. However, <br />notwithstanding any authorization you provide, any remaining Title IV credit balance will be <br />distributed at the end of each loan period or the last payment period in the award year for which the <br />funds were awarded. All other Title IV funds will be applied to the account in accordance with Title <br />IV regulations. In addition, funds will be distributed within the required timeframe upon rescission, <br />in writing, of this authorization. <br />Printed Name: <br />Last 4 digits of your Social Security Number: <br />Signature: <br />Date: <br />37 1 Page -California Truck Driving Academy - Student Catalog <br />