Fillable College of DuPage COMPANY SPONSORED BILLING AGREEMENT Attention: (College of DuPage)

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College of DuPage COMPANY SPONSORED BILLING AGREEMENT Attention: (College of DuPage)

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BROWSE COLLEGE OF DUPAGE FORMS

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College of DuPage
425 Fawell Blvd. Glen Ellyn, Illinois 60137
COMPANY SPONSORED BILLING AGREEMENT
Attention: Mary Brew
Student Registration Services
Phone: 630-942-3289 or 630-942-2377 Fax: 630-942-2878 Email: BrewM@cod.edu or Registration@cod.edu
Student, please complete.
Employee/Student Name: ______________________________ College of DuPage Student ID#: ______________
Student Social Security: _______________________________ Birth date: _________________________
(Required for College Illinois Plan)
Phone: ____________________________
If for any reason a Sponsor declines payment, the student will be responsible to reimburse the College of DuPage.
If the Sponsor does not pay, the charges will become the student’s responsibility. The student will have a hold on their record
preventing future registration or release of transcripts until the account is paid in full. Failure to pay any remaining balance will result
in the information being turned over to a collection agency.
Student Signature______________________________________________________ Date: _______________________
Sponsor, please complete.
Company Name: _________________________________________________ Term of Agreement
Company Billing Address: _________________________________________________ Fall _______
_________________________________________________ Spring _______
Company Contact Person: ____________________________ Summer _______
Company Phone: ______________
Company Authorized Signature ___________________________________________________Date:__________________________
Title of Authorized Signer ___________________________________________
Registration will not accept forms without company approval. A letter on Company letterhead must also be included with this form.
Sponsor, please check the appropriate lines.
_____ Yes, Company Will Pay In-District Tuition Rates Only ___X_ Yes, Company Will Pay Fees
OR OR
_____ Yes, Company Will Pay Out-Of-District Tuition Rates _____ No, Company Will Not Pay Fees
_____ Yes, Company Will Pay For Non Credit Classes
Please list the courses for which this agreement is valid. If nothing is provided, this agreement will be valid for all courses the student
registers for in the semester listed above.
The College of DuPage does not monitor attendance or grades. It is the responsibility of the student to supply the employer with grades.
College of DuPage Company ID #__________________________________
College Use Only
Books are billed separately by the bookstore. For additional information call the bookstore at (630)942-4342.
Please turn over – Letter agreeing to our terms on opposite side
js 10/29/20
College of DuPage
425 Fawell Blvd. Glen Ellyn, Illinois 60137
COMPANY SPONSORED BILLING AGREEMENT
Attention: Mary Brew
Student Registration Services
Phone: 630-942-3289 or 630-942-2377 Fax: 630-942-2878 Email: BrewM@cod.edu or Registration@cod.edu
D
irections for letter agreeing to College of DuPage terms:
Print or type letter below on sponsor’s company letterhead
Fill in student name
Sign and date letter
Return to Student Registration Services with Company Sponsored Billing Agreement form
This letter is to authorize ______________________________to enroll in classes at the College
of DuPage as part of a Sponsored Billing Agreement. I understand that I, as a representative of
the company, agree with the terms of the College of DuPage Sponsorship program for the
classes the student has listed on the Company Sponsored Billing Agreement. Prompt payment
is required regardless of grades or attendance.
Sincerely,
____________________________________________________________________________
Signature of Authorized Party (required)
Date (required)_______________________________
Company Sponsored Billing Directions
Sponsored Billing is available for those students whose employers will pay for their tuition and fees regardless of grades
or class attendance. If grades or attendance is required for reimbursement, the student will need to pay for the classes
and be reimbursed from their employer. The student will be responsible for all charges on their account.
• The student and sponsor must accept the terms and conditions of the Sponsored Billing Agreement.
o The Sponsor understands that the College of DuPage does not monitor grades or attendance.
o All courses the student registers for in the term listed will be billed to sponsor unless otherwise noted
on the Sponsored Billing Agreement form.
o The Sponsored Billing Agreement must be signed by both the student and the Sponsor to be effective.
o The Sponsor agrees to pay within 30 days from start of term.
o A letter from the Sponsor on company letterhead must also be provided. Sample letter attached.
Process for Sponsored Billing
1. Co
mplete all sections of the Sponsored Billing Agreement form including student and sponsor signatures.
2. Type letter agreeing to College of DuPage terms on company sponsor letterhead.
3. Fax, mail or return in person the Sponsored Billing Agreement and letter agreeing to College of DuPage terms on
company letterhead to Student Registration Services at College of DuPage. Addresses for submitting the
paperwork are on the front of the Sponsored Billing Agreement.
Upo
n receipt of the Sponsored Billing Agreement, your tuition will be deferred and your sponsor will receive an invoice
for your tuition. The student will be responsible for any charges not paid by the sponsor. If the sponsor does not pay, the
student will receive an invoice and have a hold placed on their account until paid in full.
js 10/29/20
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College of DuPage COMPANY SPONSORED BILLING AGREEMENT Attention: (College of DuPage)

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Completed 3 February 2021

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