Fillable Semester Tuition Installment Loan Application (Page 4 of 4) in pdf

SALT LAKE COMMUNITY COLLEGE

Semester Tuition Installment Loan (STIL)

APPLICATION/AGREEMENT

Application Needs to be Completed in Blue or Black Ink Only

Name (Last/First/Middle)

Complete Street Address (including City, State & Zip Code)

Personal Phone

SS# or Student ID

Co-Signer Name

Co-Signer’s Complete Street Address (including City, State & Zip Code)

Co-Signer’s Phone

Co-Signers SS#

(Required if student is under 18 yrs)

IT IS YOUR RESPONSIBILITY TO PAY ON TIME ACCORDING TO THIS PAYMENT AGREEMENT

I understand all of the provisions of the Semester Tuition Installment Loan. I understand that failure on my part to meet any of the provisions of the plan may cause my participation in the plan to be

canceled, and, at the option of the College, the balance due on my student account will become payable at once and will prevent me from further participation in the plan. I understand that SLCC

pursues all financial obligations due to the fullest extent of the law. This includes, but is not limited to: holds on registration, transcripts, grades, and graduation; liens against Utah State Tax Returns;

referrals to collection agencies; and litigation. I agree to pay any cost incurred in the collection process of this plan including, but not limited to: late charges, attorney’s fees, charges or commissions

up to 40% that may be assessed by any collection agency retained to pursue this matter. I further agree to pay interest at the rate of 1.5% per month (18% per year) on any amount over 30 days

past due. All applications are subject to final approval by the Student Loans & Receivables Department. I have read, understand and agree to all the provisions of the Semester Tuition

Installment Loan as set forth herein and on the instructions form of this application/agreement.

Student Signature

Date

Co-Signer Signature

Date

Employer Name

Complete Street Address (including City, State & Zip Code) Not one of your personal references

Employer Phone

Personal Reference Name

Complete Street Address (including City, State & Zip Code) Not living with you or other reference

Phone

Personal Reference Name