Payment Plan Agreement

By providing my electronic signature and other required information below, I am promising to make sufficient monthly payments to the extent that my student account balance will be paid in full by the end of each semester.

If I do not comply with this agreement, I may be subject to one or more of the following actions:

active holds placed on my student account
withdrawn from one or more courses
withdrawn from the University.

First Name*

Middle Initial*

Last Name*

Email*

Date of Birth*

Student ID*

Last Four Digits of Social Security Number

Todays Date

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