Payment Plan Template Page 2

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Payment Plan
Payment Calculation
12-Month Plan
10-Month Plan
Date Budget Worksheet Received by University:
Date Budget Worksheet Received by University:
May 1
1 x monthly payment is due
July 1
1 x monthly payment is due
June 1
2 x monthly payment is due
August 1
2 x monthly payment is due
July 1
3 x monthly payment is due
September 1
3 x monthly payment is due
August 1
4 x monthly payment is due
September 1
5 x monthly payment is due
__________________________________________
__________________________________________________________
Budget Worksheet
Payment Plan Application Form
I will use the Western New England University
Direct costs, full year:
Payment Plan to budget expenses for the full
Tuition
$___________________
academic year. I understand and agree to the
Room & Board
$___________________
terms and conditions as outlined in this
Fees
$___________________
application.
Application fee
$
50.00
Health Ins. (optional)
$___________________
____________________________________
$
Total Direct Costs
___________________
Signature of Person Responsible for Payments
___________________________________________
Credits, full year:
Signer’s Date of Birth
(Do not include work study award.)
WNEU Scholarships
___________________________________________
and Grants
$____________________
Parent or Guardian Name (please print)
Federal (Pell &
___________________________________________
SEOG) Grants
$____________________
Street Address
State Grants
$____________________
Federal Perkins Loan
$____________________
___________________________________________
Federal Direct Ford Loans
City
State
Zip
(deduct 1.072%)
$____________________
External Scholarships
$____________________
___________________________________________
Federal Direct Parent Plus
Telephone Number
Loan (deduct 4.29%)
$____________________
___________________________________________
Private Loan
$____________________
Email
Tuition/Room Deposits
$____________________
Payment Plan Deposit
$____________________
___________________________________________
Student Name
$
Total Credits
____________________
$
Year Budget
____________________
____________________________________________
(Costs minus Credits)
(Estimate)
Student University ID Number

Initial Payment
$______________
Check one
10-Month
12-Month
(Monthly payment x number of months due)
Divide Year Budget by
10
12
Result is Monthly
Check enclosed
$______________
$ _________ *
$_________*
Payment
Make check payable to:
Western New England University
*I understand this budget may be altered to reflect
true costs and credits.
Complete and mail this application to:
Western New England University
Student Administrative Services
1215 Wilbraham Road
Springfield, MA 01119-2684

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