I will pay my balance (charges less financial aid) in full by the due date.
Account Balance $
Pending Financial Aid $
Balance Due $
I will pay my balance in 5 installments
Monthly payment $
+ Processing Fee $
+ Payment Plan Charge $
= AMOUNT DUE TODAY $
I will pay my balance in 2 installments
Installment amount $
+ Processing Fee $
+ Payment Plan Charge $
= AMOUNT DUE TODAY $
Note: If your employer pays your tuition, please contact the Cashier's Office for a different form.
Student Name (please print or type) Responsible Party (if other than student)
Signature Signature
Date Date
Fall semester - final installment is due November 1
Spring semester - final installment is due March 1
Fall semester - monthly payments due September 1, October 1, November 1 & December 1
Spring semester - monthly payments due February 1, March 1, April 1 & May 1
Call Cashier's Office at (270) 686-4238 for assistance in completing this form.
Spring semester due date - January 5th
Fall semester due date - August 15th
I promise to pay Brescia University in accordance with the option I have selected above.
I understand that my failure to pay by the due dates specified will result in additional charges including but not limited to:
$100 late payment fee, late fee of 1.5% per month on past due balances, and any collection costs incurred by Brescia.
I understand that if the financial aid for which I have applied is not forthcoming, I am responsible for all charges incurred.
I understand that any changes in my account that result in balance that is greater than will be covered by the payment plan
I have chosen, are due and payable at the time of the change.
I understand that satisfactory settlement of my account must be made before a grade report or transcript of credits will be
issued.
I understand that if I have a past due balance, I may not be eligible for all services offered by the University and I may be
restricted from participation in University activities.
