Consortium Agreement - Lincoln Memorial University
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1__________________________________________________________________________________________________
CONSORTIUM AGREEMENT
6965 Cumberland Gap Pkwy
423.869.6336
Harrogate, TN 37752
finaid@lmunet.edu
STUDENT IDENTIFICATION & CERTIFICATION
Name:____________________________________ Student ID#: ___________________ Phone:______________________________
Address:_________________________________________City:________________________ State:__________ Zip:_____________
Visited Institution Name:________________________________________________ Enrollment Period ___/___/___ to ___/___/___
Program Contact (at visited institution):_________________________Phone:_______________________ Fax:__________________
This is to certify that I am in a degree-seeking program at Lincoln Memorial University and have been granted permission by the Registrar to be enrolled as a
transient visiting student. I certify that my enrollment includes only courses that will apply toward my degree from LMU. I understand that I must request a
transcript be sent from the visited institution to LMU at the end of the specified semester and that a hold may be placed on my account until this is
received. I will immediately notify the LMU financial aid office if there is any change in my enrollment. I understand it is my responsibility to pay the
required fees at the visited institution.
Student Signature:____________________________________________________ Date:__________________________
INSTITUTIONAL AGREEMENT
(to be completed by the Visited Institution and returned to Lincoln Memorial University)
Lincoln Memorial University agrees to:
_____________________________________ agrees to:
(Visited Institution)
Consider this student enrolled in an eligible program of study
Accept this student in a visiting transient status
and degree seeking
Notify Lincoln Memorial University Financial Aid Office if the
Grant transfer credit for all approved courses
student fails to enroll or changes enrollment status
Determine the student’s eligibility for financial aid based upon
NOT disburse any Title IV Federal aid to the student during the
the cost provided by the visited school and disburse aid
specified term
Maintain all records in accordance with federal regulations
HOME SCHOOL
VISITED SCHOOL
Lincoln Memorial University
Institution: ________________________________________________
Financial Aid Office
Attn:______________________________________________________
6965 Cumberland Gap Parkway
Address: __________________________________________________
Harrogate, TN 37752
City: _______________________ State: __________ Zip:__________
Phone: (423) 869.6336 Fax: (423) 869.6347
Phone: _______________________ Fax: _______________________
Approved for Financial Aid:
Cost of Attendance per Semester:
Enrollment Status:
_______________________________ $____________________
Tuition/Fees:
$__________________
(
) Full time
_______________________________ $____________________
Room/Board:
$__________________
(
) 3 / 4 time
_______________________________ $____________________
Books:
$__________________
_______________________________ $____________________
(
) 1 / 2 time
Personal/Travel: $__________________
Total:
$__________________
TOTAL
$____________________
(
) < 1 / 2 time
Signature: _____________________________ Date: ______________
Signature: _____________________________ Date: ______________
Title: _____________________________________________________
Title: _____________________________________________________
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