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Iowa Central College Online Student Financial Agreement

Student Name:    
E-mail Address:    
Social Security Number:    
City:    
State:    
Zip:    
Choose Your Counselor:
   
Start Date: Ex. 3/13/2007
     
     
FINANCE OPTIONS:    
Please check one Primary Finance Option (a Secondary Option is required for all students in case the primary financing plan doesn't cover 100% of costs.) Funding of at least 50% of your annual costs is required for an option to be considered primary.
 
Primary
Secondary
  
Cash Plan: 100% cash payment submitted 5 days prior to each course start date.
     
Financial Aid Plan: Federal Pell and SEOG Grant Programs, Stafford and PLUS Loans, need and non-need based programs, are available for eligible students. In order to secure deferment of tuition during the application process you must provide Iowa Central all documents required to the certification of federal financial aid funds. Continuous attendance with no attendance breaks greater than 29 days is required to retain disbursed federal financial aid funds.
     

Employer Direct Billing: Iowa Central approved Employer forms must be received by Iowa Central at least 5 days prior to start of each course. Any amounts not covered by your Employer must be paid prior to start of each course. You authorize Iowa Central to discuss any pertinent information with your employer you have indicated in order for the college to obtain payment according to the terms of this payment option.

Employer:
     

Corporate Reimbursement Plan: To be eligible you must receive 50% of your annual tuition cost form your employer. Tuition only will be deferred a maximum of 80 days from each course start date. Your credit card (no debit cards) will be automatically charged 80 days after each course start date for tuition if Iowa Central hasn't received payment. Terms of this agreement are not contingent upon receipt of a grade, completion of a course, or reimbursement by your employer. Non compliance will mean you no longer qualify for the Corporate Reimbursement Plan and you must comply with the CASH plan. I certify that I'm eligible for my employer's tuition reimbursement program.

Employer:
Annual Reimbursement Cap:
     

Military Tuition Assistance (TA): Iowa Central approved Military tuition assistance forms must be received by Iowa Central at least 5 days prior to the start of each course. Any amounts not covered by the Military TA must be paid to the start of each course. You authorize Iowa Central to discuss any pertinent information with any other third party you have indicated in order for the college to obtain payment according to the terms of this payment option.
     

Active Duty Army Tuition Reimbursement Plan: To be eligible you must receive 50% of your annual tuition cost from active duty army. Tuition only will be deferred a maximum of 80 days from each course start date. Your credit card (no debit cards) will be automatically charged 80 days after each course start date for tuition if Iowa Central hasn't received payment. Terms of this agreement are not contingent upon receipt of a grade, completion of a course, or reimbursement by your employer. Non compliance will mean you no longer qualify for the Active Duty Army Tuition Reimbursement Plan and you must comply with the CASH plan. I certify that I'm eligible for active duty tuition reimbursement program.
 
Yes
No
  
GI Bill (VA) : I will receive GI Bill funds while enrolled with Iowa Central.
Required by all students to reply as Yes or No
     

 

Credit Card Charge Authorization (Debit cards are not accepted)
   
Credit Card information is required for CASH PAY students only
 
I authorize Iowa Central to charge my credit card according to the terms of this plan for Tuition and Fees.
   
My credit card is a: Visa Master Card Discover American Express
Name as shown on credit card:
Credit Card Number:
Exp. Date:
Pin Number:
Cardholder Signature:

 

A $30.00 late fee will be assessed if a course is not paid for in accordance with the chosen financial option. In addition, $25.00 will be charged for any returned check in accordance with state law.

I have read and fully understand the information listed above. I acknowledge I have access to and have reviewed the Iowa Central online policies and procedures. I have also reviewed the Student Financial Agreement and all of my questions have been fully answered to my satisfaction. I also understand that I am financially responsible for any and all charges incurred no matter which option I have chosen.
   
Student Signature:
Date:
(By signing this form I agree to the terms above.)