Billing and Financial Permissions Form

Campus ID # *
Houghton Email *
Student Signature *
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, 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.
Signature Date *