Study Abroad Consortium Agreement Form - Study Abroad Program Page 2

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Hillsborough Community College
Office of Financial Aid Cross Enrolment Contract 2014-2015
Study Abroad Consortium Agreement
Student’s Name :
HCC ID:
Date of Birth:
Section B: To be completed by the Host Institution.
Term of Student Abroad:
____ Fall
____ Spring
____Summer
Begin/End Dates of Enrollment:______________ - ______________
Term:_______________
Hours Registered:____________
Type of Program:
____ Independent Study Abroad
____Exchange Program
____Faculty-Led Program
List of Course(s) the Student will take at the host institution:
Course Title
Credit Hours
HCC Equivalency (to be completed by HCC)
Total Costs (convert to U.S. dollars):
Tuition/Fees: $
Transportation Cost: $
Personal Expenses: $
Books & Supplies: $
Room/Board: $
Other Costs: $
Total Costs (convert to U.S. dollars): $_______________________
Officer’s Printed Name & Title
Email Address
Telephone Number & Fax Number
College or University’s Name
Street Address
Province, Country, Postal Code
Statement of agreement between HCC and the Host Institution: I certify that our drop/add period has ended and agree to notify HCC
if this student withdraws from any of the courses listed above. I agree that only HCC will process financial aid for this student and no
payment of any kind will be made to this student by the host institution.
Signature of Officer
Date Signed
Section C:
TO BE COMPLETED BY AN HCC ACADEMIC ADVISOR:
The above course(s) will be acceptable to transfer and will count towards the student’s degree requirement at HCC.
HCC Academic Advisor Signature
Date
Printed Name and Title
Hillsborough Community College | Office of Financial Aid | PO Box 31127, Tampa, FL 33631-3127
Phone: 877-736-2575 | Email: districtfinancialaid@hccfl.edu| Fax: 813-259-6020
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