Company Billing Authorization Form
MSC-ST is asking you to provide private information in order to process yourCompany Billing Authorization This information will be used to update your finacial record. You are not legally required to provide this information; however, the college may not be able to effectively process your request if you do not provide sufficient information. Access to this information will be limited to school officials, including faculty who have legitimate educational interests in the information. Under certain circumstances, federal and state laws authorize release of private information without your consent: to other schools in which you seek or intend to enroll, or are enrolled; to federal, state or local officials for purposes of program compliance, audit or evaluation; as appropriate in connection with your application for, or receipt of, financial aid; if the information is sought with a court order or subpoena; or as otherwise permitted by other state or federal law.
Company Name:
Address:

I authorize the following employee's expenses as indicated below while attending classes at MSC-ST:
Student Name:
Student ID #:

Semester:

Please indicate expenses by checking all that apply:
Tuition/Fees
Books
Supplies
Application Fee (one-time fee)


Authorized by:

Date:
Signature:
Title:
Phone: