Financial Aid - Utah State University

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STUDENT CONSORTIUM AGREEMENT
Term _______
Academic Year _______
Student Name
Last Four Digits Social Security Number
Address (street, city, state, zip)
Phone number
You must complete this form for each term of the consortium agreement.
1. To allow your financial aid budget to be calculated, fill in the number of credits you will take (or have taken) during the
current academic year at each school in the consortium:
School
Student ID for School
credits fall
credits spring
credits summer
2. List the classes from each school in which you are enrolled for the current term.
Name\Course Number of Class
Credits
School
OFFICE USE ONLY
3. TERMS OF AGREEMENT: I hereby certify that I am admitted and am working toward a degree or certificate in
_________________________ at ____________________________, and that the courses listed above will apply to that
program. I recognize that I must maintain satisfactory academic progress. I authorize the schools listed above to furnish the
other listed schools with all information (including grades, attendance information, etc.) relevant to the administration of
financial aid. I hereby agree to immediately notify the Financial Aid Office of all involved institutions should I make a course
change or withdraw before the end of the term. I recognize that it is my responsibility (whether I receive financial aid or not) to
pay all tuition, fees, and other charges for the courses for which I register when they fall due. I understand that financial aid
funds cannot automatically pay participating school(s).
Student Signature
Date
4. Submit this form together with a billing statement (showing you are enrolled) from each participating school to your LOCAL
Financial Aid Office. Your local Financial Aid Office will explain how your aid will be disbursed.
OFFICE USE ONLY:
Student has submitted proof of enrollment in above courses.
Signature, Participating School Financial Aid Administrator
Participating schools verify they ARE NOT providing financial aid for above term. Fax completed form to Disbursing School.
Student is enrolled in above degree/certificate program.
Signature, Disbursing School Financial Aid Administrator
Does student receive Donor
Disbursing School
Participating School
Participating School
Money or Scholarship at
Participating School?
No
Yes
Signature/Date
Signature/Date
Signature/Date
S.A.P/TOTAL HOURS
Amount:
Complete after grades are posted for above classes. Record grades above and fax to Disbursing School.
Source:
Cumulative Credits/School
Cumulative Credits/School
Cumulative Credits/School

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