Financial Responsibility Agreement
(Please initial next to each statement after reading)
PAYMENT OF FEES/PROMISE TO PAY
_____ I understand that when I register for any class at Fontbonne University, or receive any services from
Fontbonne University, I accept full responsibility to pay all tuition, fees and other associated costs assessed as
a result of my registration and/or receipt of services. I further understand and agree that my registration and
acceptance of these terms constitutes an agreement in which Fontbonne University is providing me
educational services and I promise to pay for all assessed costs. This includes but is not limited to tuition,
fees, campus housing, meal plans, student health insurance, parking permits, services fees, bookstore
charges and other associated costs by the published or assigned due date.
_____ I understand and agree that if I drop or withdraw from some or all the classes for which I register, I will
be responsible for paying all or a portion of tuition and fees in accordance with the published tuition refund
policy and need to so notify the Registrar. I have read the terms and conditions of the published tuition refund
schedule and understand that my failure to attend class or receive a bill does not absolve me of my financial
responsibility as described above.
_____ In the event I owe a balance from any prior semester, I agree that the outstanding obligation to
Fontbonne University will be governed by this Agreement and the amounts due from all past terms must be
paid in full before holds are removed to allow future enrollment or the ability to obtain transcripts, etc.
WITHDRAWAL
_____ In the event I need to withdraw from all or some of my courses within the semester, I understand I must
first contact my advisor and must notify the Registrar and complete the appropriate form to successfully
complete this process.
FINANCIAL AID
_____ I understand that aid described as “estimated” on my Financial Aid Award does not represent actual or
guaranteed payment, but is an estimate of the aid I may receive if I meet all requirements stipulated by that aid
program.
_____ I understand that my Financial Aid Award is contingent upon my continued enrollment and attendance
in each class, and maintaining satisfactory academic progress, for which my financial aid eligibility was
calculated. If I drop any class before completion, I understand that my financial aid eligibility may decrease
and some or all of the financial aid awarded to me may be revoked. Furthermore, I understand that my
Financial Aid is subject to change from year to year depending on my FAFSA results, GPA, etc.
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Business Office
6800 Wydown Blvd; Saint Louis, MO 63105 | Phone: (314)
889-1405 | Fax: (314) 889-4599 | BusOffice@fontbonne.edu
_____ If some or all my financial aid is revoked because I dropped or failed to attend class, or failed to
maintain satisfactory academic progress, I agree to repay all revoked aid that was disbursed to my account
and resulted in a credit balance that was refunded to me.
DELINQUENT ACCOUNT/COLLECTION
_____ Financial Hold: I understand and agree that if I fail to pay my student account bill or any monies due by
the scheduled due date, Fontbonne University will place a hold on my student account, preventing me from
registering for future classes, receiving transcripts, and receiving my diploma.
_____ Late Payment Charges: I understand and agree that if I fail to pay my student account bill or any monies
due by the scheduled due date, Fontbonne University will assess a late fee of $25.00 per month until my past
due account is paid in full.
_____ Collection Agency Fees: I understand and accept that if I fail to pay my student account bill or any
monies due to Fontbonne University by the scheduled due date, and fail to make payment arrangements
acceptable to Fontbonne University to bring my account current, Fontbonne University may refer my
delinquent account to a collection agency. I further understand that if my account is referred for collection that I
will be responsible for paying a collection fee based on a percentage at the maximum rate allowed by state
and federal regulations along with all cost and expenses, including court costs and reasonable attorney’s fees,
necessary for the collection of my delinquent account. Finally, I understand that my delinquent account may be
reported to one or more of the national credit bureaus.
METHOD OF BILLING
_____ I understand that Fontbonne University mails out statements as its official billing method; therefore, I am
responsible for reviewing and paying my student account by the scheduled due date listed on the statement. I
further understand that failure to review my bill does not constitute a valid reason for not paying my bill on time.
Updated statement information is also available online through the student portal.
_____ I understand that administrative, clerical or technical billing errors do not absolve me from my financial
responsibility to pay the correct amount of tuition, fees and other associated costs assessed as a result of my
registration at Fontbonne University.
COMMUNICATION
_____ I understand and agree that I am expected to set up a University email account for use during the time
in which I am enrolled at Fontbonne University and that all communication will be sent to this University email.
_____ I understand and agree that I am responsible for keeping Fontbonne University records up to date with
my current mailing address, email addresses, and phone numbers. Furthermore, I understand that failure to do
so does not absolve me from my financial responsibilities.
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Business Office
6800 Wydown Blvd; Saint Louis, MO 63105 | Phone: (314)
889-1405 | Fax: (314) 889-4599 | BusOffice@fontbonne.edu
COMPLIANCE WITH STUDENT LOAN RULES AND EXIT COUNSELING
_____ I understand that, if I receive student loans guaranteed by the federal government, I must
comply with the governing rules for those loans, which includes but is not limited to repayment
and exit counseling as it pertains to my obligations to repay the loans upon completion of my
studies at Fontbonne.
Student Printed Name: _________________________________________________________
Student ID #:______________________Student Date of Birth: _________________________
Student Signature: ___________________________________ Date: _____________________
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Business Office
6800 Wydown Blvd; Saint Louis, MO 63105 | Phone: (314)
889-1405 | Fax: (314) 889-4599 | BusOffice@fontbonne.edu
P
lease return this form to the Business Office located in Ryan Hall, room 215.
click to sign
signature
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