529 - ESA Form (Summer 2024)

Student Information

First Name*

Middle Initial

Last Name*

University ID Number*

Plan Information

Plan Name*

Plan ID Number*

Plan Owner*

Plan Owner Phone Number*

Credit Hours to Bill*

Please indicate the number of credit hours you would like invoiced for the summer semester. If you want the full number of credit hours to be billed please input "Full".

Requester Information

Requester First Name*

Requester Last Name*

Phone Number*

Email*

Questions

Please contact our office: 515-294-7388 or ubill@iastate.edu

Authorization

By submitting this form, I hereby authorize Iowa State University to invoice our educational savings account. I understand that this form is only valid for one academic year. Each academic year begins with the Fall semester. I also understand that Iowa State University reserves the right to return any overpayment from an educational savings account to the originating plan.