PCC Payment With Scholarships/Discount Form/User Defined Amount

PCC Payment With Scholarships/Discount Form/User Defined Amount

Use this form to pay with a debit/credit card or PayPal. If you would like to pay by check please refer to our catalog and/or payment page. This form is only for students who have already have confirmed scholarships or with students who have a sibling discount.
PCC Payment Reminders:
- Friday, April 21, 2023 - Half of tuition payment due
- Friday, May 26, 2023 - Final payment of tuition due
If you would like more information on Payments, you can also look over pccasp.org/make-a-payment

Please refer to our catalog for our refund policy as well as the payment requirements: pccasp.org/catalog

Please ONLY fill out this form if you are paying an amount not on our orginal form. For example, if you are paying half, please pay TWO months in the orginal form provided. This is only for amounts defined by scholarships
Does your student have a confirmed scholarship at this time or need to pay a user defined amout? Yes or No*

Yes, please fill out the form.NO - But I need to pay a user defined amount not listed on the other form.NO, BUT I HAVE A SIBLING DISCOUNT, please fill out the form.
Student Name *

First NameLast Name
Student ID Number *
Please look at your acceptance email letter for this number. It must be correct in order for your payment to be processed.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
What School District are you a part of? Students who attend in-district schools pay a $1950 Tuition, out of district students pay $2450 to attend the program. *
Parent/Guardian Name *

First NameLast Name
Your E-mail*
example@example.com
Phone Number*
Please enter a valid phone number.
User Amount Defined: (Please indicate the amount you are paying today)
prevnext( X )
USDPlease put in below the description of your payment (ex. Tuition Minus Scholarship)
Amount Description:*
Where is the scholarship from?
Please write "Sibling Discount" if it is not from a scholarship.
How much is the scholarship?
Please write $250 for sibling discount
Who can we contact to confirm the scholarship? (this is just in case there is an issue)
Please write N/A if for a sibling discount only.

Payment Methods

Debit or Credit Card

First Name

Last Name

Credit Card Number

Security Code

Card Expiration

Please click one of the PayPal options to complete payment and submit the form.

Should be Empty: