Student Accounts Enrollment Agreement

Student Accounts Enrollment Agreement

Financial Obligations Appeal
Students are required to pay all financial obligations in full from the prior semesters in order to enroll for the subsequent semester. Registration, housing, and other campus services will be withheld until all outstanding balances, fines, and debts are resolved including unpaid tuition and uncollected fines. Prior balances must be paid before setting up a new payment plan. Students may appeal this requirement and seek special permission to enroll and access college services and programs, by presenting information regarding the reason for the inability to pay their bill in full. As part of the appeal process, the student must present a plan for paying his or her bill in full. The student may ask family or campus personnel to provide additional information.
Student Name*

First NameLast Name
Student ID Number*
Ex: 111XXXXXX (Do not include dashes or spaces)
Email*
example@example.com
Phone Number*
Select the Year/Term for the upcoming semester you are seeking to enroll:
Select your class status for upcoming semester you are seeking to enroll:
Select your enrollment status for the upcoming semester.

Full-TimePart-Time
If Part-Time, indicate the number of credit hours:
Undergraduate
Briefly describe the circumstances that have resulted in your current financial situation:*
Briefly describe the steps you have already taken to resolve:*
Plan Includes (Select All That May Apply):*

Payment In FullPayment PlanFinancial Aid (Federal Aid)Private/Outside ScholarshipsPrivate LoanOther
Please indicate/further describe details for your plan of action for resolving your situation and eliminating your bill:*
Does your plan require a payment plan agreement that is not currently able to be set up in self-service?

NoYes
Please select the date of your first payment:

MonthDayYear
Date
Select the payment frequency:
Payment Installment Amount:
Estimated requested amount for payments
Has the FASFA been submitted for the period you are requesting enrollment?*

ReceivedNot ReceivedWaivedUnknown
Additional Contacts for Appeal Committee

The student may ask family or campus personnel to provide additional information.
Will anyone else provide additional details for your appeal?*

NoYesUnknown
Provide the Name and Contact Information of the Individual:*

First NameLast Name
Relationship to Contact:
Phone Number of Contact:
Please enter a valid phone number.
Email Address of Contact:
example@example.com
PAYMENT DETAILS

PAYMENT PLAN POLICY
- The payment agreement will need to be set up and completed through self-service once your arrangements have been finalized.
- Email reminders of the payment date will be sent before the due date.
- Automatic drafts will be initiated if the installment has not been remitted by the payment due date.
- There is no penalty for early payment or paying the full account balance ahead of the payment schedule.
PAYMENT METHODS
- The student may remit payment via cash, check or credit card to be applied to the installment amount scheduled.
- If you need to make changes to the information you provided in this agreement you may make those changes in self-service ePayment, contact the billing office via phone 620.229.6251or 620.229.6318 or email:accounts@sckans.edu for any questions
MISSED INSTALLMENTS
- Payment will be attempted on the due date.
- In the result of a decline, the account or credit card will be tried three additional times beginning the day after the initial attempt.
- If there are insufficient funds you will be responsible for all fees associated with the insufficient funds from the bank. A $25 returned check charge will be incurred.
WITHDRAW FROM COURSES
- Southwestern College maintains the right to cancel the auto payment plan at any time if the terms and conditions are not followed. Missed installments or defaulted payment agreements will result in the student being administratively withdrawn from any future session courses.
- Notification of the administrative withdraw will be sent electronically through email from the registrar's office email: registrar@sckans.edu
- Course withdraw will also result in reservations of any on campus housing being forfeited. Deposit deadlines for housing contract will apply.
By signing below, I acknowledge the agreement stated in this form. I also confirm that all information I entered in this form is true and accurate.

I understand that failure to comply with my financial obligations may result in my inability to use payment plans, inability to enroll, and inability to access academic records (Grades and Transcripts) as well as being administratively withdrawn from courses.
Signature of Student

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Date Signed

MonthDayYear
Date
Should be Empty:

Student Accounts Enrollment Agreement

Additional Contacts for Appeal Committee

PAYMENT DETAILS