Payment Intent Agreement
NEW TRADITIONAL UNDERGRADUATE
Instructions: Using the tables below, follow steps 1 through 3 to calculate your charges, financial aid, and anticipated
balance due for the upcoming year. In step 4, please indicate what method you will be using to pay any
remaining balance (if you have a balance), and finally in step 5, sign the agreement to pay. Your balance is
determined by semester and is calculated by subtracting all applicable financial aid and payments from the
semester’s charges. This calculation chart can help you determine your anticipated balance for each semester
and the academic year, as well as provide options to reduce immediate out-of-pocket cost. Students should
not wait for an official bill from NCU before calculating balances or making payment arrangements.
This agreement must be submitted by July 1, 2009 or before you can register for classes.
STEP 1: Charges FALL SPRING YEAR
Tuition ($11,450/sem – 12 to 18 credits) $ $ $
(Part-time cost per credit: $770)
Parking Fee $ $ $
($180/yr. Typically charged Fall)
Athletic Fee $ $ $
($150 per sport - charged in semester sport played)
Miscellaneous Fees $ $ $
(Pvt music/voice lessons, etc.)
Health Insurance $ $ $
($880/yr Approx. – if not covered. Charged Fall)
Room and Board ($3400/semester) $ $ $
(singles - $4150 Burke-Griffith $4400 Richart per semester)
Total Charges (anticipated)* $ $ $
*Although not included in total charges, you may incur other costs for books and other educationally related expenses not billed by NCU. You may be able to
receive loans or other aid to cover such expenses.
STEP 2: Credits/Anticipated Funds FALL SPRING YEAR
Financial Aid (from Award Letter)** $ $ $
Additional Aid NOT already listed on award letter:
Parent PLUS Loan** $ $ $
Private Student Loan** $ $ $
Outside Scholarships/Gifts Total $ $ $
Payments/Deposits already sent $ $ $
**Subtract out loan fees (1% for Stafford loans and 3% for
Parent PLUS loans – figures are estimates only).
Total Credits/Anticipated Funds $ $ $
STEP 3: Anticipated (subtract total credits For FALL For SPRING For YEAR
Balance Due from total charges) $ $ $
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Northwest Christian University 828 East 11 Avenue Eugene, OR 97401 www.northwestchristian.edu
STEP 4: Method of Payment – Select your method(s) of payment from the options below for any anticipated balance due
calculated in Step 3. Indicate what your method of payment will be for EACH semester. Choose Option 1 for Fall and/or
Spring if you do not have an anticipated balance due in that semester.
Payment Options For FALL For SPRING
Option 1 – No Payment
Based on my calculations from steps 1 through 3 I have no anticipated balance due.
Option 2– Cash Payment $______________ $______________
I will bring a cash payment to the Business office In cash by the first day of class In cash by the first day of class
Option 3 – Check/Money Order $______________ $______________
Payment enclosed Will be mailed by
Will be mailed by
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January 5th
August 15
Option 4 – Credit Card Payment I will call with credit card I will call with credit card
info by August 15th info by January 5th
Option 5 – NCU Payment Plan ($75 enrollment fee)
8 Month Payment Plan - Divide total anticipated Balance for year by 8. My payment amount will be
$____________ per month beginning September 5, 2009 and ending April 5, 2010.
10 Month Payment Plan - Divide total anticipated Balance for year by 10. My payment amount will be
$____________ per month beginning August 5, 2009 and ending May 5, 2010.
STEP 5: Agreement to Pay – By signing below, I agree to pay any anticipated remaining balance by the method indicated
above. If paying by payment plan I agree to make monthly payments for the amount and timeframe indicated above. I will be
charged a one-time $75 fee that will be added to the student account balance for enrolling in this plan. If at any point this
agreement lapses because of non-payment, or a payment is received past the due date, a finance charge of 1.5% per month
will be assessed and I will be required to pay this fee over and above the remaining balance. I must notify the Business Office
immediately if the estimated charges described above change, or are incorrect, as the details of this agreement may need to
be changed. This agreement can be in effect for up to one full academic year. Should I decide on paying by a different
method than indicated above, I will notify the Business Office immediately.
Student Name:__________________________________________ Street Address: _____________________________________________
Student Signature:_______________________________________ City/State/Zip: ______________________________________________
Date:______________________________ Email:_____________________________________________________
Return this signed Payment Intent Agreement to the Admissions Office by July 1, 2009 or
before you register for classes.
Questions concerning charges, billing, or making payments? Contact Darcy Nolte in the Student Billing Office at (541) 684-7213 or
dnolte@northwestchristian.edu. Questions concerning your anticipated aid? Contact the Financial Aid Office at (541)-684-7211 or email us
at finaid@northwestchristian.edu. Additional copies of this worksheet are available on our website.
Official Use Only
Admissions Receipt Date:__________ Billing Office charges checked Financial Aid checked
Entered into GM Payment Plan Processed Copy sent to student
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Northwest Christian University 828 East 11 Avenue Eugene, OR 97401 www.northwestchristian.edu