Summer Standard Payment Plan Request Form
Student’s name _________________________________________ Email _____________________________________
Program City & Program Name _______________________________________________________________________________________
The charge for this deferred payment plan is $50.00 and must be submitted along with 50% of the total program fee and this
form. This plan may be used with or without the CIEE Financial Aid Deferral Plan. If you wish to combine the plans, please
subtract your anticipated financial aid refund amount from your original invoice balance to calculate the base figure for your
Standard Payment Plan. A new billing statement, outlining the revised payment schedule, will be available on the student’s
CIEE account within 7 – 10 business days of receipt of the completed Standard Payment Plan request.
Payment Schedule Payment Contact (Required)
Person in the US who we can contact in the case of
Base Figure: $ billing issues while you are abroad.
(PLEASE PRINT):
Contact Name
Relationship to student
Contact’s Full Mailing Address
Contact’s Email Address (REQUIRED)
Contact’s Daytime Telephone (REQUIRED)
By signing below, I acknowledge that I am ultimately responsible for ensuring that my CIEE program fees are paid in full.
If payments are not made as outlined, I am fully liable for any applicable late fees as explained in the CIEE Payment
Policies. I am fully liable for all outstanding program fees as determined by CIEE’s Withdrawal or Deferral Refund policy,
should I choose to withdraw from the program before it begins or once it has begun.
Student’s Signature Date
Payment plans will not be processed until after the full first installment payment has been received.
Please return the completed form by email to studybillingteam@ciee.org.
$50.00
Plan Participation Fee
+$
(50 % of Base Figure above)
=$
(to be delivered with this form)
$
(25 % of Base Figure above)
$
(25 % of Base Figure above)
CIEE COLLEGE STUDY ABROAD
click to sign
signature
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