4-Month Semester Payment Plan Application

4-Month Semester Payment Plan Application
Application Date *

MonthDayYear
Date
Student Legal Name *

First NameLast Name
Student ID Number: *
Student Email*
example@example.com
Payment Plan Type: 4-Month Payment Plan (If charges change during the term, any balance will be added to, or deducted from the total amount scheduled. Please note this plan ends the last month of the term listed below. Every semester a student will need to enroll in a new semester payment plan.)
Term applying for: (Please select 1 option)- A non-refundable $25 enrollment fee will be charged to the student billing account. Please be advised that 4-month plans are only available in the Fall and Spring semester. Payment plans do not rollover to the next semester.*

Fall (September - December)Spring (January - April)
Are you currently living, or have you been accepted to live, in on-campus housing?*

YesNo
Are you reserving a semester parking pass at an AAC parking lot?*

YesNo
Mark this option if the person submitting this application is not the student and complete the below fields.
Full legal name of person submitting the application:
Relationship to student:
Contact Email:
Signature*

Clear
Should be Empty: