APPROVED DENIED
Per Board Policy 5030:
1. Students in the Peralta Community College District may opt to pay their non-resident tuition or enrollment fee through an installment
payment plan.
2. Students who owe fees from the current or previous terms may opt to pay these fees through an installment payment plan. Students
are required to pay at least $25 of their owed fees and develop an installment payment plan prior to enrolling in classes. Students can
only participate in one payment plan.
3. New foreign students are required to pay at least the non-resident tuition for 12 units plus all other required fees for both the fall &
spring semesters prior to enrollment in their first year classes.
4. The payment plan will be interest free.
5. The payment plan will include the specific amount and due date for each installment. All of the payments will be completed within the
term for which the enrollment is made.
6. Failure to make timely payments will subject the student to the penalties described in Board Policy 5035.
• If approved, the payment plan will automatically adjust to display your current account balance if you should add or drop any courses
from your class schedule. Refer to the list of Peralta District fees at the following link: http://web.peralta.edu/admissions/fees/.
• All payments can be mailed to the Bursars Office on campus or online in your Passport Student Center: https://pa.peralta.edu.
• As per district policy, if you do not drop your classes by the appropriate date, you will be billed for your courses. Please consult the
academic calendar at the following link: http://web.peralta.edu/admissions/category/academic-calendar/.
• Email the completed form to paymentplan@peralta.edu if unable to submit electronically, if you have any further questions and/or
would like to cancel the payment plan.
FIRST NAME:__________________________ MI:______ LAST NAME:____________________________ STUDENT ID #:_______________
ADDRESS:__________________________________ CITY:______________________________ STATE:_________ ZIP CODE:____________
HOME PHONE #:______________________ MOBILE PHONE #:_______________________ EMAIL:________________________________
I agree to pay my semester tuition fees for any previous and current terms. I will pay my current balance in four (4) equal
installments on or before the sixth (6th) of each month starting in the month designated by the PCCD Office of Finance & Administration
(see below). I realize that failure to fulfill this agreement will affect my future payment plan eligibility and my current payment plan may
be canceled.
STUDENT'S ELECTRONIC SIGNATURE:______________________________________________ DATE:______________________________
Applicant's full printed name (in lieu of a signature) is required for eligibility
After submission, you will receive an email within 3-5 business days with the status of your request.
If approved, the payment schedule/installments shown below will be posted in your Passport
Student Center (https://pa.peralta.edu/) under finances.
PLEASE NOTE:
REASON FOR DENIAL:_________________________________________________________________
_________________________________________________________________
Processed By:____________________________________ Date:_______________________ STUDENT CONTACTED? YES NO
TERM(S):___________________________________
PCCD INSTALLMENT PAYMENT PLAN CONTRACT
STUDENT PAYMENT PLAN AGREEMENT
