Term: Summer Fall Spring Year: STUDENT FINANCIAL RESPONSIBILITY AGREEMENTFinancial Responsibility Agreement • September 14th, 2020
This Agreement is made by and between you and the Colorado Community College System, including Arapahoe Community College, Community College of Aurora, Community College of Denver, Colorado Northwestern Community College, Front Range Community College, Lamar Community College, Morgan Community College, Northeastern Junior College, Otero Junior College, Pueblo Community College, Pikes Peak Community College, Red Rocks Community College, Trinidad State Junior College, and the System Office, hereinafter collectively referred to as the “College”.
FINANCIAL RESPONSIBILITY AGREEMENTFinancial Responsibility Agreement • July 28th, 2022
The patient is expected to present an insurance card at each visit. All co-payments and past due balances are due at time of check-in unless previous arrangements have been made with a billing coordinator. We accept cash, check or credit cards. Absolutely no post-dated checks will be accepted.
Financial Responsibility AgreementFinancial Responsibility Agreement • October 6th, 2023
At the time of registration for any semester or term, every student is required to accept the Texas A&M University- Corpus Christi (TAMUCC) Financial Responsibility Agreement, the terms of which follow below. If the agreement is declined, registration will not be allowed.
Student Financial Responsibility AgreementFinancial Responsibility Agreement • July 30th, 2019
By enrolling in classes at the University of Wyoming (UW), a student makes a financial commitment to pay the tuition and fee charges associated with that enrollment.
FINANCIAL RESPONSIBILITY AGREEMENT SELF PAY or NON-APPROVED HOSPITAL SERVICESFinancial Responsibility Agreement • April 10th, 2023
The Lindner Center of HOPE (LCOH) appreciates the confidence you have shown in choosing us to provide health care services to you or a patient for whom you have responsibility. Our patient and family-centered treatment philosophy requires that we openly communicate our policies and expectations about payment for our services before treatment is initiated. Please take a moment to familiarize yourself with these policies.
FINANCIAL RESPONSIBILITY AGREEMENTFinancial Responsibility Agreement • June 9th, 2021 • Connecticut
FINANCIAL RESPONSIBILITY AGREEMENT SELF PAY or NON-APPROVED HOSPITAL SERVICESFinancial Responsibility Agreement • October 20th, 2021
The Lindner Center of HOPE (LCOH) appreciates the confidence you have shown in choosing us to provide health care services to you or a patient for whom you have responsibility. Our patient and family-centered treatment philosophy requires that we openly communicate our policies and expectations about payment for our services before treatment is initiated. Please take a moment to familiarize yourself with these policies.
Student Financial Responsibility AgreementFinancial Responsibility Agreement • March 26th, 2020
FINANCIAL RESPONSIBILITY AGREEMENTFinancial Responsibility Agreement • May 5th, 2023 • Illinois
FINANCIAL RESPONSIBILITY AGREEMENTFinancial Responsibility Agreement • March 17th, 2022
Student Financial Responsibility AgreementFinancial Responsibility Agreement • May 6th, 2015
If you or your parents would like more information about the Student Financial Responsibility Agreement you can contact the Student Business Services at 9364686960 or sbs@sfasu.edu
INSURANCE & FINANCIAL RESPONSIBILITY AGREEMENTFinancial Responsibility Agreement • March 19th, 2018
Welcome to Arbor View Oral & Facial Surgery (AVOFS). This form is designed to help you understand dental insurance, payments and financial responsibility of the patient, as these can all be complicated.
Financial Responsibility AgreementFinancial Responsibility Agreement • November 30th, 2022
Student Financial Responsibility AgreementFinancial Responsibility Agreement • March 15th, 2018 • Colorado
Tuition and Fees are always due the first business day after Census Day. There is a 5 business day grace period. Therefore, any payment not received by the close of business (4pm MST) on the last day of the grace period will be assessed a late fee. I acknowledge that any tuition, fees, and fines that are not paid in full by the end of the grace period, the amount of funds erroneously disbursed to me, and any other financial obligations to Mines will automatically be considered past due and/or owing and incur applicable late payment fees. I understand that if any of my financial obligations to Mines are not paid in full or any funds erroneously disbursed to me are not returned to Mines, Mines will, to the extent permitted by law, refuse to allow me to register for additional classes, withhold release of my transcripts and diploma, and take action against me to collect any unpaid or unreturned amounts owing under my Student Account, including assignment of the Student Account for collect
Financial Responsibility AgreementFinancial Responsibility Agreement • October 21st, 2022
Responsibility. I understand I am responsible for all payment obligations arising out of my treatment and care and I guarantee payment for these services. At each visit, please be sure we have your current demographic and insurance information. It is your responsibility to provide us with this information, and update it if it changes. You will be responsible for any charges billed to the wrong insurance carrier as a result of not providing accurate insurance information. I understand I am responsible for any deductibles, co-payments, co-insurance or any other patient responsibility amounts indicated by my insurance carrier or for any services not covered by my insurance. We participate in most insurance plans, if your insurance is not a plan we participate in, you will be self-pay and payment plans are available.
Financial Responsibility AgreementFinancial Responsibility Agreement • July 22nd, 2022
HAWAI’I PACIFIC UNIVERSITY -- FINANCIAL RESPONSIBILITY AGREEMENTFinancial Responsibility Agreement • June 22nd, 2023
Under HPU’s Registration Policies and other University policies, I am responsible for paying my portion of tuition and fees, along with all other University charges and costs then due, by each term’s tuition payment deadline. If there is a difference between expected and actual financial aid, I am responsible for paying any balance on my account resulting from this difference promptly. HPU’s Tuition and Fee Schedule (a full listing of student tuition and fee charges) is available on our website: https://www.hpu.edu/tuition. Tuition and fees are subject to change, and this website will host the most up-to-date information. Tuition payment deadlines are always several weeks before the start of the semester, and are published in the Academic Calendar (https://www.hpu.edu/registrar/academic-calendar.html).
FINANCIAL RESPONSIBILITY AGREEMENTFinancial Responsibility Agreement • May 9th, 2022
Financial Responsibility AgreementFinancial Responsibility Agreement • August 2nd, 2018
NCS uses FACTS Management Company in order to process all tuition payments. Each NCS family should access the FACTS Management Company website and enroll in a tuition payment plan. The details for each of the payment plan options are as follows:
FINANCIAL RESPONSIBILITY AGREEMENT PLEASE SIGN AND RETURN TO THE BURSAR’S OFFICEFinancial Responsibility Agreement • August 10th, 2021
Financial Responsibility AgreementFinancial Responsibility Agreement • March 22nd, 2024
Financial Responsibility AgreementFinancial Responsibility Agreement • June 2nd, 2022
REED COLLEGE | BUSINESS OFFICE | 2019–20Financial Responsibility Agreement • May 5th, 2020
By registering for courses at Reed College, I accept responsibility for payment by the due date of all college charges assessed to my student account, including tuition, fees, and late payment fees. I fully accept this debt as my personal financial responsibility. I acknowledge that non- attendance does not relieve me of financial responsibility for the courses in which I am enrolled and that I will access my bill online to remain informed of any outstanding balances or other financial obligations. It is my responsibility to keep all of my contact information up to date by contacting the business office via the information provided at reed.edu/business.
STUDENT FINANCIAL RESPONSIBILITY AGREEMENTFinancial Responsibility Agreement • September 29th, 2022
This Agreement is made by and between you and the Colorado Community College System, including Arapahoe Community College, Community College of Aurora, Community College of Denver, Colorado Northwestern Community College, Front Range Community College, Lamar Community College, Morgan Community College, Northeastern Junior College, Otero College, Pueblo Community College, Pikes Peak State College, Red Rocks Community College, Trinidad State College, and the System Office, hereinafter collectively referred to as the “College”.
Financial Responsibility AgreementFinancial Responsibility Agreement • October 3rd, 2006
This is a legally binding agreement between Southwestern Colorado Ear, Nose and Throat Associates, and you, as the patient. It describes your financial obligations. You must read this, sign it and return it to us prior to your first treatment. The term “SCENT” means Southwestern Colorado Ear, Nose and Throat Associates. The terms “I”, “me”, “my”, “you”, or “your” refer to the patient.
FINANCIAL RESPONSIBILITY AGREEMENTFinancial Responsibility Agreement • May 18th, 2018
Please also be advised that your visit may include certain procedures that include, but are not limited to biopsies, microscopic and/or endoscopic examination, wax removal that are not included in the standard office visit. These procedures will be billed separately and in addition to office visit charges. We have become aware that many insurance carriers are classifying these procedures as “surgery” and applying the charges to a higher deductible amount. These will also appear on their statements (or “explanation of benefits”) as “Surgery.” The result may be an insurance payment for an office visit but not a procedure. In such cases, payment for the procedure is the patient’s responsibility. Be assured that we are following accepted billing and coding guidelines and that all procedures are performed in the interest of patient care.
Financial Responsibility AgreementFinancial Responsibility Agreement • November 26th, 2019
This Financial Responsibility Agreement describes Trauma Informed Therapies’ (TIT) policy regarding payment for services rendered by TIT.
Student Financial Responsibility AgreementFinancial Responsibility Agreement • May 6th, 2015
This agreement provides valuable information pertaining to payment of tuition and fees, delinquent accounts, financial aid, method of communication and other important topics. This agreement will be required to be acknowledged and submitted by all students each spring and fall prior to registration.
FINANCIAL RESPONSIBILITY AGREEMENT AND ASSIGNMENT OF RIGHTS AND BENEFITSFinancial Responsibility Agreement • September 3rd, 2020
FINANCIAL RESPONSIBILITY AGREEMENTFinancial Responsibility Agreement • January 25th, 2021
This certifies that the above named individual agrees to pay in full for all professional services rendered at the time they are performed, unless other arrangements are made in advance of the set appointment. The below named guarantor understands a $ 10.00 returned check fee will be charged along with any appropriate collection or attorney’s fee which may accrue upon collection of any outstanding balance.
FINANCIAL RESPONSIBILITY AGREEMENTFinancial Responsibility Agreement • March 11th, 2022
• Special High School applicants (admission option for students outside of PSEO, for students that have not participated in PSEO or CE due to eligibility or other factors)
Financial Responsibility Agreement 2015-2016Financial Responsibility Agreement • February 5th, 2015
All Tuition payments will be made through FACTS Tuition Management Company at https://online.factsmgt.com. Payments through FACTS Tuition must be made either through an automatic bank-to-bank transfer of funds from an authorized checking or savings account or by credit card. Please note that there is a 2.75% convenience fee for any credit card payments made.
Financial Responsibility AgreementFinancial Responsibility Agreement • February 23rd, 2022
Payment for all charges appearing on your electronic student bill and statement must be received by the payment due date to avoid late fee charges. Any money still owed after the due date may be assessed a late fee of $65.00 per occurrence.
Agree to Pay ScreenFinancial Responsibility Agreement • February 8th, 2022
• I understand that if I decide not to attend the courses, which I am registering for, that it is my responsibility to drop the course(s) by the due date to avoid any financial liability.
FINANCIAL RESPONSIBILITY AGREEMENT & AUTHORIZATION TO TREATFinancial Responsibility Agreement • August 14th, 2020
Total Care Orthotics and Prosthetics agrees to provide prosthetic/orthotic/pedorthic device(s) and/or service(s) to me as prescribed by my physician(s).
