"Personal Financial Responsibility Form"
FINANCIAL RESPONSIBILITY FORM FOR MAY TERM TRAVEL COURSES The purpose of this form is to provide the student with an understanding of the financial obligations and responsibilities for any May Term Travel Course he or she may go on. The total course charges will be put on the student's account at the beginning of January. Any loans related to the May term travel course will be reflected on the student's account as soon as the loan is processed (normally in January or February). TODAY'S DATE NAME OF MAY TERM TRAVEL COURSE DATE LEAVING DATE RETURNING FACULTY CONTACT Estimated costs of the travel course to be billed on Student Account Other out-of-pocket estimated costs of the travel course Total estimated costs of the travel course NON-REFUNDABLE DATES AND AMOUNTS AMOUNT FOR WHICH YOU WILL BE Officially Dropped Class in Registrar's Office: RESPONSIBLE Before (fill in date) (fill in amount) After (fill in date) (fill in amount) After (fill in date) (fill in amount) After (fill in date) (fill in amount) If you do not drop classes by (fill in date) , you will be responsible for the entire amount of $0.00 and will NOT be eligible for any refund from the travel course, even if you do not go. The cost is an ESTIMATE and does NOT include personal spending money or meals not covered under the travel course. The charges for the travel course will be put onto your student account at the beginning of the 2010 winter/May term. You might be eligible for a loan that can be used to cover the cost of the travel course. If you decide not to go on the travel course, loans offered for the May term travel course may be taken away and your student account will still be charged according to the above schedule. If you are on a board plan AND are gone for 5 consecutive days or more, you will receive a pro-rated board credit. If you live on campus AND are gone for 5 consecutive days during May term, you will receive a pro-rated room credit. The room & board for May term will be billed at the beginning of the winter term. The appropriate amount will be credited to your student account at the beginning of February 2010. See the Controller's Office for the appropriate credit amount for your situation. If the travel course is cancelled, the College will attempt to recover any funds that were paid as deposits. Refunds for the travel course will be given to the extent that the College can recover any such funds. There is a risk that you might not be refunded the complete cost of the travel course if it has to be cancelled. I have read the above information and understand and agree with this information. Currently, I am committed to going on the May Term Travel Course mentioned above. However, if I decide not to go, I will be charged according to when I officially drop the class in the Registrar's Office and the schedule noted above and agree to pay the amount in full. In addition, I understand that if the travel course is cancelled, there is a possibility that I will not receive a full refund for the cost and will be responsible for paying for any non-refunded cost. STUDENT'S NAME (Please Print): STUDENT'S ID NUMBER: STUDENT'S SIGNATURE DATE File: May Term Travel Course form - 09-10 - ELECTRONIC