Authorization Form - HEERF II Distribution

I acknowledge that I have been duly notified by Benedictine College that I am to be the recipient of funds distributed by Benedictine College from the Higher Education Emergency Relief Fund II (HEERF II) as authorized by the Corona Response and Relief Supplemental Appropriations Act, 2021 (CRRSAA), Public Law 116-260, signed into law by President Donald J. Trump on Dec. 27, 2020. As a recipient, I am directing Benedictine College to disburse the funds to me in manner of my choice: (Select One)

I request to have my distribution funds applied to the unpaid balance of my student billing account. If the account becomes paid in full, I am directing Benedictine College to apply these funds toward future educational charges I will incur for the upcoming academic term. I request to have my distribution funds applied to the unpaid balance of my student billing account. If the account becomes paid in full, I am directing Benedictine College to refund the remaining funds directly to me. I request to have the distribution funds refunded to me.

Refund requests will be issued electronically (eRefund) using the information currently on file with the Benedictine College Business Office. If the student does not have eRefund account information on file with the College, the refund will be issued in the form of a paper check and mailed to the home address on file for the student.

Student Name*

First Name

Last Name

Student Email*

Student ID*