Fillable CERTIFICATION TO SOUTHWEST VA COMMUNITY COLLEGE (SWCC) OF (Southwest Virginia Community College)

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CERTIFICATION TO SOUTHWEST VA COMMUNITY COLLEGE (SWCC) OF (Southwest Virginia Community College)

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CERTIFICATION TO SOUTHWEST VA COMMUNITY COLLEGE (SWCC) OF
AUTHORIZATION OF PAYMENT OF STUDENT TUITION/FEES
Revised 04/07/14 Page 1 of 2
Original form shall be completed & signed by official authorized by employer/agency &
shall be submitted to the SWCC Business Office.
All information except signatures shall be typed.
Date: _________________________
THIS IS TO CERTIFY TO SWCC THAT______________________________________________
Name of Employer or Agency
Employer/Agency FEIN_______________ Telephone No.________________ Ext.________
Mailing Address 1:___________________________________________________________
Mailing Address 2:___________________________________________________________
City_______________________________ State_____________ Zip Code______________
HAS AGREED TO PAY TO SWCC TUITION/FEES EXPENSES, FOR STUDENTS AS LISTED BELOW,
DURING_________________SEMESTER, 20_____. IT IS FURTHER AGREED THAT FINANCIAL
AID AWARDS WILL BE APPLIED TO THE STUDENT’S ACCOUNT LAST; THEREFORE SWCC WILL
BE INVOICING THE ABOVE NAMED EMPLOYER/AGENCY FOR THE FULL AMOUNT OF
TUITION/FEES AMOUNT AUTHORIZED BELOW PRIOR TO FINANCIAL AID BEING AWARDED.
______________________________________________________
Signature of Official Authorized by Employer/Agency Date
BUSINESS OFFICE USE ONLY:
Initial Review by:____________Date:_______ Keyed by:_______________ Date________
Final Review by:_______________ Date:_______
Student Empl ID
Last Name, First Name
Authorized
Tuition/Fee Amount
SWCC TPC Attach. A.
GRAND TOTAL
CERTIFICATION TO SOUTHWEST VA COMMUNITY COLLEGE (SWCC) OF
AUTHORIZATION OF PAYMENT OF STUDENT TUITION/FEES
Revised 04/07/14 Page 2 of 2
SWCC TPC Attachment A
Student Empl ID
Last Name, First
Name
Authorized
Tuition/Fee
Amount
SUB TOTAL
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CERTIFICATION TO SOUTHWEST VA COMMUNITY COLLEGE (SWCC) OF (Southwest Virginia Community College)

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Completed 27 July 2020

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