Company Deferment Information Form
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1______________________________________
STUDENT ID #_________________
PLEASE DO NOT WRITE ON THIS LINE
Not Social Security Number
SEMESTER________________
Bursar’s Office
COMPANY DEFERMENT INFORMATION FORM
***Please complete and send with your company approval form for each semester***
Student Name:
___________________________________________________________
Phone Numbers:
Home______________________ Office__________________________
P
L
E
A
S
E
N
O
T
E
:
P
L
E
A
S
E
N
O
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E
:
Email Or
______________________________________
Home Address
______________________________________
This form should be
______________________________________
submitted to the TU
______________________________________
Bursar’s Office during the
first month of the semester
Company Name:
______________________________________
Company Contact:
___________________________Phone # ________________________
Company Address:
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
Your Company’s Reimbursement Plan:
Check appropriate boxes
After Grades:
100%______
________ Payment Includes:
80%______
________ Tuition
75%______
________ Student Assoc. Fee
50%______
________ Lab/Art Fees
Other______
________ Law Fees
I understand that the above specified portion of the tuition is due thirty (30) days after the last day of
school each semester. I also understand that an 18% annual finance charge may accrue on any portion
of my tuition charges that are not paid when due and that all other policies regarding unpaid balance may
apply. I understand that this agreement does not guarantee continued enrollment nor release of a
transcript if my tuition and/or related charges are unpaid. This agreement does not remove my obligation
for full payment of all tuition and related charges.
SIGNED: _______________________________________ DATE: __________________________
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