TO BE COMPLETED BY STUDENT. To Host School: From Home School School Name: Address: Hagerstown Community College 00000 Xxxxxxxxx Xxxxx Hagerstown, MD. 21742-6514 Student Name: Birthdate: Term: Address: City, State, Zip Under this consortium agreement, the student will:
TO BE COMPLETED BY STUDENT. I qualify for the tuition benefit under my employer’s policy; therefore, I request that payment of tuition in the amount of $ for the Summer 2019 term be deferred until the end of the term. I understand and agree that if, for any reason, my employer refuses payment, or I withdraw from classes and do not qualify for reimbursement, I will be responsible for the immediate and full payment of all tuition due to Central Penn. Print Name of Student Signature of Student Student ID # Date Email Address Daytime Phone Number Cell Phone Number By signing this Agreement, I agree to all of its terms. I further agree and understand that if I do not pay the entire amount owed (including any deferred amount) plus any administrative fees owed before September 27, 2019, I may incur additional costs for collecting the amounts due under this Agreement, including reasonable attorneys fees, court costs and collection agency fees. I release my rights under the Xxxxxxx Amendment and agree to allow the College to release my financial information to my employer. Questions and Assistance Mailing Address Xxx Xxxxxxxx – Student Accounts Central Penn College 1-800-759-2727 ext. 2233 Business Office
TO BE COMPLETED BY STUDENT. In consideration for having access to public networks, I hereby release Rockdale County Public Schools and its officers, employees, and agents from any claims and damages arising from the use of the public networks. I have read and agree to comply with Internet Acceptable Use procedures as stated in Policy Regulations IFBG-R. I also understand that any violation of the procedures is unethical and may constitute a criminal offense. Should I commit any violation, my access privileges may be revoked and disciplinary action taken. Student Name: School: Student ID #: Grade Level: Student Signature: Date:
TO BE COMPLETED BY STUDENT. I have read the MCS District Chromebook Use Agreement. I agree to abide by the rules contained therein. I understand that use of the Internet and Network at MCSD is a privilege and I will abide by the MCSD Acceptable Use of Computers & Internet Policy (4526). I understand that I may only use the Internet and Network for educational purposes as directed by my teachers. I will not access inappropriate materials on the Internet. I understand that if I commit any violation of the policy, I will lose my access privileges and may be disciplined for my actions. The District may post or publicize student work or photos on the school website in accordance with the Family Educational Rights Act that is available on the school’s website. Student’s Name (please print): Grade: Student’s Signature: Date: To Be Completed by all Parents/Guardians/PIPRs: I have read the MCS District Chromebook Use Agreement. I agree to the rules contained therein. I give permission for my child to participate in the use of the Internet and Network at MCSD. I realize that s/he will be able to access major networks throughout the world using the Internet. I understand that this access is designed and intended for educational purposes only. I have read the MCS Acceptable Use of Computers & Internet Policy (4526) with my child. We agree to abide by the rules contained therein. I understand that MCS prohibits students from accessing inappropriate materials and will not hold MCSD accountable for unsuitable materials acquired by my child through Internet use at school. The District may post or publicize student work or photos on the school website in accordance with the Family Educational Rights Act that is available on the school’s website. Child’s Name (please print): Grade: Parent/Guardian/PIPR’s Name (please print): Parent/Guardian/PIPR’s Signature:
TO BE COMPLETED BY STUDENT. Student Name: ______________________________ Social Security Number: ____________________ Mailing Address: ___________________________________ Phone Number: ____________________ ___________________________________ I fully authorize the above institutions to release all information pertaining to my Financial Aid application. I certify that my enrollment includes only courses that will apply toward my degree from Tusculum College, and that it does not include correspondence or web based courses. ______________________________________ Student’s Signature
TO BE COMPLETED BY STUDENT. I, (student’s name) , request that National Louis University, my home school where I expect to receive a degree, and (←name of host school where courses that I will use toward my NLU degree will be taken), enter into a Consortium Agreement so that my enrollment at the host school can be used to determine my financial aid eligibility. NLU ID Number: Term deadlines: Summer: June28, 2013, Fall: October 25, 2013, Winter: February 21, 2014, Spring: May16, 2014 Term requested: Summer 2013 Fall 2013 Winter 2014 Spring 2014 Number of Credit Hours: (Must be transferable to NLU)
TO BE COMPLETED BY STUDENT. Student’s Name UA ID # Last First M.I Mailing Address Phone number ( ) Date of Birth Last Grade Completed Semester for which student is applying Fall Spring Summer 20
TO BE COMPLETED BY STUDENT. Name: Student ID# / Phone: Address: City Zip Enrollment term: WNCC program: Fall 20 Associate of Arts Associate of Occupational Studies Spring 20 Associate of Science Certificate Summer 20 Associate of Applied Science Diploma Chadron State College enrollment information: Course # Credit Hours Course Name Check if interested in ordering your consortium books from WNCC’s Buddy’s Books & Bistro. You will receive an email notification when the credits have been approved. I understand that I must be seeking a degree, certificate or diploma at Western Nebraska Community College and that my Chadron State College courses must apply to my degree. I also understand I am receiving financial aid from WNCC and I must maintain Satisfactory Academic Progress in accordance with WNCC’s Financial Aid Office policy. If requested, I will provide a copy of an official document verifying my course(s) completion to WNCC. Failure to do so may result in financial aid suspension. I understand my award will be based on my enrollment status according to WNCC enrollment policies and will be disbursed to me by Western Nebraska Community College’s Business Office. I am responsible for paying educational expenses at Chadron State College and give my permission for Chadron State College to release any necessary academic and financial information (e.g. college transcripts) from the above courses to WNCC. Signature of student: Date:
TO BE COMPLETED BY STUDENT. STUDENT NAME _ _ Cell Phone_ _ STUDENT EMAIL ADDRESS STUDENT NUID HOME INSTITUTION (Peru State College) STUDENT ID HOST INSTITUTION NAME OF HOST INSTITUTION MAILING ADDRESS OF HOST INSTITUTION _ _ PHONE NUMBER OF HOST INSTITUTION _ FAX NUMBER_ THE COURSES I WILL BE TAKING AT THE HOST INSTITUTION ARE AS FOLLOWS: SEMESTERCOURSE # CREDIT HRS COURSE NAME BEGIN DATE END DATE _ _ _ _ _ _ _ _ _ _ _ _ I CERTIFY THAT I AM SEEKING A DEGREE FROM PERU STATE COLLEGE. I UNDERSTAND I MUST BE ENROLLED IN AT LEAST 6 CREDIT HOURS AT PERU STATE COLLEGE. I UNDERSTAND THAT I WILL RECEIVE MY FINANCIAL AID FROM PERU STATE COLLEGE BASED ON MY ENROLLMENT AT BOTH INSTITUTIONS. I REALIZE THAT I WILL BE RESPONSIBLE FOR MAKING PAYMENT TO THE HOST INSTITUTION. I ALSO UNDERSTAND THAT I MUST MAINTAIN SATISFACTORY ACADEMIC PROGRESS IN ACCORDANCE WITH PSC’S POLICY AND I AUTHORIZE PSC TO OBTAIN A FINAL GRADE REPORT FOR THE ABOVE LISTED COURSES FROM THE HOST INSTITUTION. STUDENT SIGNATURE _ DATE STUDENT: Forward to the Xxxx of your Division for completion of Section B. For Office Use FA Form 32CNSF-32CNSS- 32ZCNS Revised 10-01-20 X.X. Xxx 00 ◆ Xxxx, Xxxxxxxx 00000-0000 ◆ 000-000-0000 ◆ Fax: 000-000-0000 ◆ XXX.XXXX.XXX/XXXXXXXXXXXX PSC is an equal opportunity institution. PSC does not discriminate against any student, employee or applicant on the basis of race, color, national origin, sex, sexual orientation, gender identity, disability, religion, or age in employment and education opportunities, including but not limited to admission decisions. The College has designated an individual to coordinate the College’s non-discrimination efforts to comply with regulations implementing Title II of the Americans with Disabilities Act, Titles VI and VII of the Civil Rights Act, Title IX, of the Education Amendments of 1972, the Age Discrimination Act of 1975, and Section 504 of the Rehabilitation Act. Reports regarding discrimination or harassment may be directed to the following Compliance Coordinator. In addition, inquiries regarding non-discrimination policies and practices may be directed to the Compliance Coordinator: Xx. Xxxxxxx Xxxx, Peru State College, Administration Building, Xxxx 000, XX Xxx 00, 600 Xxxx STUDENT NAME NUID _
TO BE COMPLETED BY STUDENT. In consideration for having access to public networks, I hereby release Rockdale County Public Schools and its officers, employees, and agents from any claims and damages arising from the use of the public networks. I have read and agree to comply with Internet Acceptable Use procedures as stated in Policy Regulations IFBG-R. I also understand that any violation of the procedures is unethical and may constitute a criminal offense. Should I commit any violation, my access privileges may be revoked and disciplinary action taken. Student Name: School: Student ID #: Grade Level: Student Signature: Date: SECTION B | TO BE COMPLETED BY PARENT OR GUARDIAN I have read the Internet Acceptable Use procedures, as stated in Policy Regulations IFBG-R. I understand that access is designed for educational purposes. Rockdale County Public Schools has taken precautions to eliminate controversial material. However, I also recognize that it is impossible for the Rockdale County Public Schools to restrict access to all controversial materials and I will not hold the system responsible for materials acquired on the public network(s). As the parent/guardian of the student named above, I hereby give permission to issue an account for my child and certify that the information on this form is correct. Parent/Guardian Name: Parent/Guardian Signature: Date:
