Semester Response Form: Fall 2019

Please provide the address, city, state, zip code, and phone number of the authorized parent/agency/sponsor below:

Notice:

• You may rescind authorization at any time by notifying the Student Accounts Office in writing of your decision.
• If you wish to "accept" a student loan offer, you must complete the student loan application process in order for loan funds to be applied to your account.
• You will be responsible to pay any balance due that is not covered by your financial aid, or that is created on your account as a result of a change in your enrollment or eligibility for financial aid grants and/or loans.

**Notice:
You will need to waive/accept your Student Health Insurance charge by creating an account and logging into Gallagher Student

Your printed first and last name and Student ID will serve as your electronic signature for the purposes of the releases above.