Document 28203

Sample Authorization Letter
Your Letterhead
Lansing Community College
7120-Student Finance
PO Box 40010
Lansing MI 48901-7210
Ph: 517-483-1272 Fax: 517-483-9858
LETTER OF AUTHORIZATION
DATE:
/
/
accepts the financial obligation of the employee student as indicated below.
_______________
(Your Company Name Here)
We understand that our company is responsible for payment of tuition and fees even if the employee/student
drops classes during the time that LCC offers only 50% refund or during 0% refund.
STUDENT NAME:
STUDENT BIRTHDATE:
or LCC STUDENT #
INSTITUTION: Lansing Community College
SEMESTER:
Fall
AUTHORIZED
and/or
Spring
Summer
(please circle one) Year
COURSES:
AMOUNT: $
Choose one of the following billing options for sponsored employees/students who may be eligible to receive
financial aid:
_____Bill our company first for our student’s tuition and/or fees.
_____Bill our company first if a student is receiving loans only (money that must be repaid).
_____Bill financial aid first if a student is receiving grants and/or scholarships (gift aid).
PLEASE SUBMIT BILLING TO:
Your Contact Person:
Your Street Address:
City:
Your Phone Number:
State:
(
)
Zip:
-
*PAYMENT WILL BE DUE WITHIN 30 DAYS OF RECEIPT OF INVOICE
AUTHORIZED SIGNATURE: ______________________________________________________________________
AUTHORIZED NAME/TITLE: ____________________________________________________________________
TIN (tax id number): __________________________
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