Great Bay Community College Financial Aid Deferment Form
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1Financial Aid Deferment Form
Payment Deferment for Financial Aid Recipients is valid for 45 days into the semester - STUDENTS NEED
TO ACCEPT FINANCIAL AID AND COMPLETE ALL REQUIRED DOCUMENTATION INCLUDING
MAKING PAYMENT ARRANGEMENTS FOR OUTSTANDING BALANCE AFTER FEDERAL AID IS
APPLIED PRIOR TO THE START OF CLASSES MAY BE ASSESSED A SERVICE FEE OF $50.00
Student Data
Name: __________________________________________________________
Student ID: A_____________________
Current Address: _______________________________________________________ DOB:______________________
City: _____________________________________________________ State: ___________ ZIP: ___________________
Phone: __________________________________ Email:_______________________________@____________________
Current Employer: __________________________________________________ Work Phone: ___________________
Personal References
Name: _______________________________________
Name: _______________________________________
Address: _____________________________________
Address: _____________________________________
City, State: __________________________________
City, State: __________________________________
Phone: ______________________________________
Phone: ______________________________________
Relationship: ________________________________
Relationship: ________________________________
ATTENTION: THIS DEFERMENT IS A DEBT THAT MUST BE REPAID
1. Prior to the start of each semester a payment plan can be established on-line with Nelnet (FACTS) through the Business Office
webpage for the remaining balance after you subtract your estimated Financial Aid listed above. Federal Work Study (FWS)
should not be subtracted as it is paid directly to the student once earned.
2. My acceptance indicates that I fully understand that this deferment is granted pending completion of my financial aid file,
verification of my eligibility, certification of satisfactory academic progress and confirmation of enrollment. I also understand that
any changes in my enrollment status may result in a balance on my electronic student account statement for charges incurred at a
CCSNH institution, which I am responsible to pay. If a loan is part of my financial aid award, I certify that I will complete all loan
applications.
3. Payments must be made in accordance with the terms of this deferment agreement. I understand that I am not eligible to
receive transcripts, and/or diplomas until all charges have been paid.
Student Acknowledgement
I agree that by registering for courses at a CCSNH institution, I am financially obligated for ALL costs related to the registered
course(s). Upon a drop or withdrawal, I agree that I will be responsible for all charges as noted in the student catalog and handbook. I
further understand that if I do not make payment in full, my account may be reported to the credit bureau and/or turned over to an
outside collection agency. I also agree to pay for the fees of any collection agency, which may be based on a percentage of the debt up to
a maximum of 35%, and all additional costs and expenses, including any protested check fees, court filing costs and reasonable
attorney’s fees, which will add significant costs to my account balance.
Signature:____________________________________________ Date: _______________________
OFFICE USE ONLY: ____ Summer
____ Fall
____ Spring
Staff Approval: __________ Date: ________
Credits: _______
Tuition/Fees: ___________________ Total Est. Aid: $__________________
College Services One Stop 320 Corporate Drive Portsmouth, NH 03801
603-427-7610askgreatbay@ccsnh.edu
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