Fillable 2019-20 Consortium Agreement (Lehigh Carbon Community College)

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2019-20 Consortium Agreement (Lehigh Carbon Community College)

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______________________________________ _____________________________________
OFFICE OF FINANCIAL AID
4525 Education Park Drive, Schnecksville, PA 18078
P 610
.799.1133| F 610.799.1798
E finaid@mymail.lccc.edu
2019-20 Consortium Agreement
Student Name LCCC Student ID
This AGREEMENT, made between Lehigh Carbon Community College, Schnecksville, Pennsylvania, hereinafter known as
the "HOME INSTITUTION" and __________________________ here in after known as the "HOST INSTITUTION"
provides documentation of cross-registration for the purpose of establishing eligibility for financial aid for the student
referenced above.
The HOST INSTITUTION hereby agrees to accept the registration of the STUDENT subject to its published policies and
regulations for the following courses as a non-degree seeking candidate who intends to transfer the credits earned to the
HOME INSTITUTION. The HOST INSTITUTION also agrees to monitor attendance and enrollment in the following courses
in accordance with this agreement and Title IV regulations.
Semester: ________________
NON LCCC COURSE(s) LCCC COURSE EQUIVALENT
COURSE NO. TITLE CR. COURSE NO. TITLE CR.
________________________________________ ________________________________________
________________________________________ ________________________________________
________________________________________ ________________________________________
________________________________________ ________________________________________
THE HOME INSTITUTION HEREBY AGREES TO ACCEPT, AS A TRANSFER CREDIT SUBJECT TO ITS PUBLISHED POLICIES AND
REGULATIONS, THE ABOVE LISTED COURSE(S) AND APPLY THE COURSE(S) TO THE DEGREE REQUIREMENTS OF THE
STUDENT.
THE STUDENT SHALL BE RESPONSIBLE FOR PROPERLY REGISTERING AT THE HOST INSTITUTION AND FOR PAYMENT OF
ALL CHARGES AND FEES INCURRED AT THE HOST INSTITUTION AND SHALL BE SUBJECT TO ALL ACADEMIC AND
ADMINISTRATIVE REGULATIONS SET FORTH BY THE HOST INSTITUTION.
THE STUDENT SHALL BE RESPONSIBLE FOR REQUESTING THAT A PROPERLY CERTIFIED TRANSCRIPT OF ACADEMIC
CREDIT FROM THE HOST INSTITUTION BE SENT TO THE HOME INSTITUTION WITHIN 30 DAYS OF THE CONCLUSION OF
THE SEMESTER INDICATED ABOVE.
This agreement shall terminate at the conclusion of the semester indicated above.
HOME INSTITUTION: HOST INSTITUTION:
Signature of LCCC Academic Advisor/Date Signature of Financial Aid Office Administrator/Date
_______________________________________
__________________________________ _____________________________________
__________________________________ _____________________________________
To be completed by the Financial Aid Office at the Host School
Host School Information
Name of School/Program: _______________________________________
Address: _______________________________________
Enrollment Period: ___________________ to __________________
Cost of Attendance: Registered Credits:
Tuition and fees
$_______________ Fall _________
Room and Board $_______________ Spring _________
Books and Supplies $_______________ Summer _________
Transportation $_______________
Personal/Misc. $_______________
Other ____________ $_______________
TOTAL: $__________ ____
CERTIFICATION
A. The Host School certifies that the student has been accepted for enrollment in the program listed above.
B. The Host School agrees not to pay the student Pell Grant and/or campus-based funds or process a Stafford Loan during the
enrollment period listed above. Further, the Host School agrees to notify the Home School if the student withdraws from
the program before its conclusion. Satisfactory conclusion of the program will be evidenced by an academic transcript upon
written request of the student.
C. The Home School agrees to provide payment to the student, if eligible, for the appropriate period of time. Payment will be
made in such a manner as agreed to between the Home School and the student. It is the student’s responsibility to pay the
Host School.
Host School:
Financial Aid Administrator Signature Name
Date Phone Number Title
Return this form to:
Financial Aid Office
Lehigh Carbon Community College
4525 Education Park Drive
Schnecksville, PA 18078-2598
Email: finaid@mymail.lccc.edu
Fax: 610-799-1798
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2019-20 Consortium Agreement (Lehigh Carbon Community College)

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Completed 4 October 2020

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