Billing and Financial Permissions Form

Campus ID # *

You can lookup your Campus ID number here. (It will be a string of characters following the pattern 'P0000#####')

Houghton Email *

Student Signature *

I understand that I am responsible for all obligations and charges to my Houghton College student account as described in the college catalog. I also understand that I am responsible for reasonable attorney’s fees and/or collection costs on any past due account. I agree to reimburse Houghton College or a third party servicer acting on its behalf the fees of any collection agency which may be based on a percentage at a maximum of up to 39% of the debt, and all costs and expenses, including reasonable attorney’s fees that are incurred in such collection efforts. I authorize Houghton College to use my Federal Title IV Financial Aid funds to cover all applicable institutional charges, as well as non-institutional charges (e.g. health insurance fees). I authorize Houghton College to apply Federal Title IV Financial Aid to prior-year charges up to a maximum of $200, if I have enough financial aid to cover my current year charges and have excess financial aid. I understand that this agreement will be in effect during the time I have an open account with Houghton College. I understand that if there is a credit on my account, I can request that a refund be issued to me in the amount of my credit balance, or if I have loans, I can request that some or all of my credit balance be returned to the lender within 30 days of disbursement.

By signing below, I acknowledge that I am fully responsible for my college bill, sent via electronic notification to my Houghton College email address. I understand that it is my responsibility to add authorized users within the electronic billing system, such as parents/guardians, if I would like them to receive billing statement notifications. I acknowledge my consent to participate in electronic billing transactions for any/all financial information, including notices and authorizations for all Federal State, and Institutional aid and billing.

Confirmation of Electronic Signature *

I, the student filling out this form, warrant the accuracy of the information I have provided herein. I understand that checking this box constitutes a legal signature confirming that I acknowledge and agree to all of the conditions specified in this form.

I agree

Signature Date *

Billing and Financial Permissions Form

Houghton University
1 Willard Avenue
Houghton, NY 14744

+1-800-777-2556
+1-585-567-9200
admission@houghton.edu

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