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SS/EM.45 3/18/05 |
FINANCIAL AID CONSORTIUM AGREEMENT
Under the consortium agreement,
a student from
before a
Student
Name____________________________________________________________________
SSN______________________________________
Host
School_____________________________________________________________ Academic
Period_____________________________________
The host institution agrees to
provide an official transcript of the student’s academic record to
provide notification if the
student withdraws or never attends the approved course(s). YTC will only apply the amount of aid based
on the number of credits actually taken at the institution. It is the student’s responsibility to pay the
tuition and fees at the host institution by the required payment
deadline.
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TO BE COMPLETED BY HOST INSTITUTION
Annual Student Budget:
Tuition ________________________
Fees ___________________________
Room & Board __________________
Books & Supplies ________________
Miscellaneous/Personal ____________
Gas and Transportation ____________
Total number of hours enrolled at host institution___________________
Course(s)___________________________________________________
Total number of hours enrolled at
Is the student receiving /eligible for any of the following
awards:
Lottery Tuition Assistance Program $____________________________
LIFE Scholarship
$___________________
Institutional Award (if any____________________________________)
Total ___________________________
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Total number of hours
enrolled at York Technical College __________________ |
Total number of hours
enrolled at host institution_____________________ |
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Course(s)
_________________________________________________________ _________________________________________________________________ |
Course(s)_____________________________________________________ _____________________________________________________________ |
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Lottery Tuition Assistance
Program $___________________________________ |
LIFE Scholarship
$_____________________________________________ |
The student’s signature below authorizes YTC to release
an academic transcript to the host institution and certifies that the student
has read
and understands all the information listed above.
_____________________________________________________________________________________________________________
Student’s Signature
Date
Agreement to the above information is acknowledged by the
undersigned:
_______________________________ __________________________________
YTC
_________________________________________ _____________________________________________
YTC Authorized Official, Records Office Date Host
Authorized Official, Records Office Date