Section 2 Home College Completes Approved Denied
Home College Department Chair or Designee, Print Name and Sign Date
Home College V.P. of Academic Affairs or Designee, Print Name and Sign Date
Section 3 Student Completes
I authorize the Home College to pay my tuition and fees to the Host College for the course(s) listed out of my
financial aid award for the current academic year. I understand that payment will be made to the Host College
and I accept responsibility for any unpaid balances at both institutions. I understand it is my responsibility to
make sure all balances are paid at each institution.
I authorize the Host College to release an official copy of my transcript to the Home College at the end of the
semester. I understand all credits will be counted as attempted hours for Financial Aid purposes and that
transfer credits do not affect CGPA at the Home College. Credit for the course(s) will be accepted as transfer
credit by the Home College provided grade earned is a “C” or better and credit has not been earned via Challenge
Exam, Credit by Exam or Pass/Fail grading. Transfer credits do not affect grade point average.
Student, Print Name and Sign Date
Section 4 Home College Completes
The Financial Aid Office at the Home College has a financial aid package accepted by the student. He/she is
eligible for financial aid in the amount listed below to pay tuition and fees at the Host College for the semester
specified in this consortium agreement.
$______________________ is the amount of Financial Aid available for the host college.
Home College Financial Aid Officer, Print Name and Sign Date
Section 5 Host College Completes
It is agreed that only the Home College will award the student financial aid for the semester specified and the
Home College will monitor the student’s enrollment. I have reviewed the registration for the student for the
semester specified and can confirm that, as of today, the student is registered for the course(s) listed above.
Total cost of the tuition and fees for the Host College course(s) listed is $_____________________
Host College Financial Aid Office, Print Name and Sign Date
Information regarding your tuition, fees, other costs, and enrollment status at both the Home and Host
institutions can be found by logging into the Student Information System (SIS) for the respective school. For
information regarding financial aid, please review the CCSNH Student Financial Aid Handbook.
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