Academic Deposit Form

Academic Deposit Form

This form is used by staff to verify permission to access funds in student savings account for academic-related expenses, specified below.
Staff Name

First NameLast Name
Staff Email
Firstname.Lastname@startingrightnow.org
Student Name

First NameLast Name
Student Email
example@example.com
Expense Amount ($)
Type of Expense:

Other
In order to pay for your {typeOf}, {staffName} is requesting you confirm the following:

I, {studentName}, give Starting Right, Now permission to access funds in my checking/savings account in the amount of ${expenseAmount} to pay for {typeOf}. I understand that, in addition to the dollar amount provided (${expenseAmount}), there may be a processing fee required for the payment.
Today's Date

MonthDayYear
Signature
Name
Stage
Should be Empty: