Tuition Payment Plan Agreement

Tuition Payment Plan Agreement

This form may be used if you desire to pay your tuition in installments. You must meet all due dates that the university establishes.
This form is to be completed before the start of each academic term. Payment covers Tuition and Student Services fees only.

Monthly installment invoices are sent automatically to the student’s UHSA Email address and are due each month.
Student Name*

First NameMiddle NameLast Name
Country of citizenship
Social Security Number*
No credit check. Used for identity purposes and in the event of default.
Payment Options*

Two installmentsFour installments
Choose the term that you are currently seeking to pay in installments.*

Term (I-IV) Basic SciencesTerm (VI) Review of the Basic SciencesTerm (VII-X) Clinical Sciences
Student ID Number*
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Terms and Conditions
1. I agree to pay my tuition balance under the terms of the plan.
2. I agree that the plan can’t be changed or canceled after it is submitted.
3. I agree to pay malpractice insurance before applying for my installment (clinical students).
4. If I pay by check and it is returned for insufficient funds, I will pay the penalty and late fee plus a $40 returned check fee.
5. I understand that any tuition payments received are first applied against the oldest outstanding amounts.
Late Payment Policy
1. If installment payments are not paid in full within five of the installment payment deadline, students will be assessed a $100 late payment fee. Weekends and holidays are counted towards the late days. Late payments will not be waived unless it is a university error.
2. Payments not received after 14 days will result in being administratively withdrawn from the academic term.
3. I understand that failure to pay my dues can result in the loss of any scholarships or grants.
4. If I fail to pay my installments on time, on more than one occasion, then I will be ineligible for future payment plans.
5. If I have any outstanding tuition balance, I will not be able to enroll in future classes until I fulfill my obligation and risk my student enrollment status.
6. It is my responsibility to adhere to the due dates and avoid any additional fees.
I understand and agree to the terms and conditions stated above. I also understand that a UHSA official must first approve this agreement before the initiation of a payment plan.

Non-Discrimination Policy

It is the policy of the University of Health Sciences Antigua to provide equal educational opportunities for all people, regardless of race, color, religion, national origin, sex, age, marital status, personal appearance, sexual orientation, gender identity, and expression, family responsibilities, political affiliation, disability, source of income, residence or business, and veteran status.
Date*

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Date
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