Financial Information - Electronic Communication Consent Form

Financial Information

Communication Consent Form
Center for Allied Health Education provides electronically financial aid award information, notifications, disclosures and award letters. This form provides an individual the opportunity to opt-out of receiving financial information via electronic method or to provide the Center with an alternative email address to receive financial information only.
Name*

PrefixFirst NameLast Name
Social Security Number: *
LAST FOUR DIGITS ONLY
Email Address*
Address*

Street Address

Street Address Line 2

CityState

Zip Code
I would like to receive financial information at the:*

E-mail Address Listed Above (2-3 business days)Mailing Address Listed Above (5-7 business days)
I certify that the above information is true and correct.
Signature*

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