Financial Responsibility Statement
Financial Responsibility Statement
Student Name:
Student Name:
*
First
Last
Date of Birth
Date of Birth
*
/
MM
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DD
YYYY
Student ID Number (A00000000)
Must be
9
characters.
Currently Entered:
0
characters.
FINANCIAL RESPONSIBILITY STATEMENT
PAYMENT OF FEES/PROMISE TO PAY
I understand that when I register for any class at SUNY Orange or receive any service from SUNY Orange I accept full responsibility to pay all tuition, fees and other associated costs assessed as a result of my registration and/or receipt of services. I further understand and agree that my registration and acceptance of these terms constitutes a promissory note agreement (i.e., a financial obligation in the form of an educational loan as defined by the U.S. Bankruptcy Code at 11 U.S.C. §523(a)(8)) in which SUNY Orange is providing me educational services, deferring some or all of my payment obligation for those services, and I promise to pay for all assessed tuition, fees and other associated costs by the published or assigned due date. I understand and agree that if I drop or withdraw from some or all of the classes for which I register, I will be responsible for paying all or a portion of tuition and fees in accordance with the published Tuition Refund Policy. I have read the terms and conditions of the published tuition refund schedule and understand those terms are incorporated herein by reference. I further understand that my failure to attend class or receive a bill does not absolve me of my financial responsibility as described above.
METHOD OF BILLING
I understand that SUNY Orange uses electronic billing as its official billing method, and therefore I am responsible for viewing and paying my student account e-bill by scheduled due date. I further understand that failure to review my e-bill does not constitute a valid reason for not paying my bill on time.
DELINQUENT ACCOUNT/COLLECTION
Financial Hold: I understand and agree that if I fail to pay my student account bill or any monies due and owing SUNY Orange by the scheduled due date, SUNY Orange will place a financial hold on my student account, preventing me from registering for future classes, requesting and receiving my diploma.
Late Payment Charge:
I understand and agree that if I fail to pay my student account bill or any monies due and owing SUNY Orange by the scheduled due date, SUNY Orange will assess a late payment charge of $50.00 on the past due portion of my student account until my past due account is paid in full.
Collection Agency Fees:
I understand and accept that if I fail to pay my student account bill or any monies due and owing SUNY Orange by the scheduled due date, and fail to make acceptable payment arrangements to bring my account current, SUNY Orange may refer my delinquent account to a collection agency. I further understand that I am responsible for paying the collection agency fee which may be based on a percentage at a maximum of 33 percent of my delinquent account, together with all costs and expenses, including reasonable attorneys fees, necessary for the collection of my delinquent account. Finally, I understand that my delinquent account may be reported to one or more of the national credit bureaus.
Awards, Scholarships, Grants:
I understand that all awards, scholarships, and grants awarded to me by SUNY Orange will be credited to my student account and applied toward any outstanding balance. I further understand that my receipt of a prize, award, scholarship, or grant is considered a financial resource according to federal Title IV financial aid regulations, and may therefore reduce my eligibility for other federal and/or state financial aid (i.e., loans, grants, Federal Work Study) which, if already disbursed to my student account, must be reversed and returned to the aid source.
BILLING ERRORS
I understand that administrative, clerical or technical billing errors do not absolve me of my financial responsibility to pay the correct amount of tuition, fees and other associated financial obligations assessed as a result of my registration at SUNY Orange.
RETURNED PAYMENTS/FAILED PAYMENT AGREEMENTS
If a payment made to my student account is returned by the bank for any reason, I agree to repay the original amount of the payment plus a returned payment fee of $25.00. I understand that multiple returned payments and/or failure to comply with the terms of any payment plan or agreement I sign with SUNY Orange may result in cancellation of my classes and/or suspension of my eligibility to register for future classes at SUNY Orange.
PRIVACY RIGHTS & RESPONSIBILITIES:
I understand that SUNY Orange is bound by the Family Educational Rights and Privacy Act (FERPA) which prohibits SUNY Orange from releasing any information from my education record without my written permission. Therefore, I understand that if I want SUNY Orange to share information from my education record with someone else, I must provide written permission by following the FERPA Guidelines. I further understand that I may revoke my permission at any time as instructed in the same procedure.
IRS FORM 1098-T
I agree to provide my Social Security number (SSN) or taxpayer identification number (TIN) to SUNY Orange upon request as required by Internal Revenue Service (IRS) regulations for Form 1098-T reporting purposes. If I fail to provide my SSN or TIN to SUNY Orange, I agree to pay any and all IRS fines assessed as a result of my missing SSN/TIN.
STUDENT AGE
I understand and agree that if I am younger than the applicable age of majority when I execute this agreement that the educational services provided by SUNY Orange are a necessity, and I am contractually obligated pursuant to the Doctrine of Necessaries.
ENTIRE AGREEMENT
This agreement supersedes all prior understandings, representations, negotiations and correspondence between the student and SUNY Orange, constitutes the entire agreement between the parties with respect to the matters described, and shall not be modified or affected by any course of dealing or course of performance. This agreement may be modified by SUNY Orange if the modification is signed by me. Any modification is specifically limited to those policies and/or terms addressed in the modification.
Accepting your Charges
I accept financial responsibility for my SUNY Orange bill during the semester indicated above. I acknowledge that my tuition and fees must be paid by the due date or I will be assessed a $50.00 late payment fee. I realize that non-attendance will not relieve my financial responsibility.
Important Note:
Changes to registration and/or charges applied to your account may alter the balance due. Accepting these charges includes accepting additional charges incurred when making changes to your account for the semester.
I have read and understand the SUNY Orange refund policy and NYS residency requirements for the:
Semester:
*
Semester:
Summer 2024
Fall 2024
Winter 2025
Spring 2025
Summer 2025
You must accept your charges by typing your electronic signature/name for your
legal name
:
*
Date of Electronic Signature
Date of Electronic Signature
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MM
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YYYY