Financial Aid Office P.O. Box 309 Jamestown, NC 27282
Phone: 336.334.4822 Option 3 Fax: 336.217-8468
Student Name: GTCC ID:
Host Institution: Term:
I hereby authorize the Host Institution listed above to release financial and academic information to Guilford Technical
Community College for the purposes of determining financial aid eligibility.
Student Signature Date
The student listed above is seeking a degree or certificate from Guilford Technical Community College (GTCC) and plans
to enroll at the Host Institution listed above during the 2019-20 academic year. This Consortium Agreement will allow
GTCC to disburse financial aid based on the student’s combined enrollment at both institutions. GTCC is responsible for
determining eligibility and awards, disbursing aid, monitoring academic progress, keeping records, returning funds, and
federal reporting requirements. After all GTCC charges are paid, GTCC will disburse any excess aid to the student. The
student is responsible for paying any charges, or using any refund(s) to pay the charges at the Host Institution.
The Host Institution agrees to complete this form, to confirm enrollment, to inform GTCC if the student withdraws
from these courses, to send GTCC an official transcript at the end of the semester, and to not give the student any Title
IV grant aid during this enrollment period. If the student wishes to receive Federal loans at both the home and host
institutions, documentation of non-institutional costs must be provided to GTCC.
Host School Section:
Enrollment Period: From month day year Tuition and Fees:
To month day year Books and Supplies:
Last day to drop these courses: Host School Aid for this term:
List Course Information OR Attach Schedule
Name of Course Course Number
Please Confirm the Number of
Enrolled Credits
Total Credits =
Host Institution Guilford Technical Community College
Printed Name:
Signature Authority:
Fax Number: (336) 217-8468
Telephone or E-mail:
Please return this completed form to: GTCC Financial Aid Office, PO Box 309, Jamestown, NC 27282
or FAX to 336-217-8468.
Revised 02/06/2018
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