Fillable JSRCC FINANCIAL AID CONSORTIUM AGREEMENT (J Sargeant Reynolds Community College)

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JSRCC FINANCIAL AID CONSORTIUM AGREEMENT (J Sargeant Reynolds Community College)

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BROWSE J SARGEANT REYNOLDS COMMUNITY COLLEGE FORMS

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Home Institution Host Institution
J. Sargeant Reynolds Community College (JSRCC) Institution Name:
Office of Financial Aid Street Address:
P.O Box 85622 City:
Richmond, VA 23285-5622 State: Zip:
Fax Number: (804) 371-3739
Fax Number: (
)
JSRCC FINANCIAL AID CONSORTIUM AGREEMENT
Section I: To Be Completed By The Student
Name:
EmplID Number:
Street Address:
Contact
Number:
( )
City:
State:
Zip:
Email
Address:
Consortium Term: Fall:
Spring:
Summer:
Statement of Authorization
I agree to the following terms and conditions:
• To submit this form to JSRCC Office of Financial Aid upon completion by myself and my Academic
Advisor.
• To inform JSRCC Office of Financial Aid immediately if I choose not to enroll or otherwise cancel my
participation in the program.
• To allow JSRCC and my Host Institution to share information relating to my enrollment and financial aid
eligibility.
• To maintain Satisfactory Academic Progress (SAP) requirements
• To r
equest the Host Institution
to mail an official transcript of all class grades to the JSRCC Office of the
Registrar.
• To only enroll in class(es) that will transfer into my current program of study and understand that failure to
do so will result my consortium agreement being denied.
I understand that:
• JSRCC will not provide an early release of financial aid or send payments to my Host Institution and
therefore, I am responsible for paying any tuition and fees to the Host Institution out of pocket prior to
their
payment deadlines.
• U
nder no circumstances will my financial aid be disbursed until after the last day to drop a class with a
refund for the latest term for which I am enrolled.
• This agreement does not guarantee an increase in the amount of financial aid I will be eligible to receive.
Student Signature:____________________________________
Date:____________________
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Section II: To Be Completed By JSRCC Academic Advisor and Registrar
I have reviewed the program of study for the student listed in Section I above and affirm that the courses
listed below are acceptable for transfer and will be applied toward the student’s current degree or certificate at
J. Sargeant Reynolds Community College, if completed with a grade of “C” or better.
Course Title Credit Hours Start Date End Date
Ex: ENG 111 3 8/26/2019 12/14/2019
JSRCC Academic Advisor Signature:__________________________________ Date:_________________
Printed Name: _______________________________ Department:_______________________________
Registrar Staff Signature: _________________________________ Date: __________________
Section III: To Be Completed By Host Institution
Statement of Certification:
The Host Institution agrees to:
• Not process or award any Federal Title IV financial aid for this student.
• Share information about this students enrollment including notifying JSRCC if the student withdraws from
the program or decreases enrollment before its conclusion.
Is the Host Institution eligible to award Federal Title IV financial aid?
I agree to the Statement of Certification above and confirm that the student in Section I is enrolled in only the
approved classes listed above in Section II at (name of institution)___________________________________.
Comments:_______________________________________________________________________________
Host Institution Financial Aid
Office Staff Signature:__________________________________________
Print Name:_________________________________ Email: _____________________________________
Office Phone: _________________________
Office Fax: _____________________________
Upon completion please email or fax form to Shannon Turner at sturner@reynolds.edu or (804) 371-3739.
Yes
No
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Section IV: To Be Completed By JSRCC Office of Financial Aid (all other sections must
be completed)
Approved Financial Aid:
Award Name:
________________________________________
________________________________________
________________________________________
________________________________________
________________________________________
________________________________________
________________________________________
________________________________________
Amount:
_______________________________
_______________________________
_______________________________
_______________________________
_______________________________
_______________________________
_______________________________
_______________________________
Total Eligibility: $_________________________
Under this consortium agreement, JSRCC:
Agrees to process the student’s Title IV financial aid application and provide payment of Title IV
funds (if eligible) as appropriate for the consortium agreement.
Will calculate Return of Title IV (R2T4) funds, when needed.
Will maintain Title IV record keeping and reporting requirements.
Will maintain all records in accordance with federal regulations.
JSRCC Financial Aid Office Staff Signature: ________________________________ Date:____________
Printed Name: ___________________________________ Office Phone Number: ____________________
J. Sargeant Reynolds Community College (JSRCC)
Office of Financial Aid
P.O. Box 85622
Richmond, VA 23285-5622
Fax: (804) 371-3739
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JSRCC FINANCIAL AID CONSORTIUM AGREEMENT (J Sargeant Reynolds Community College)

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Completed 27 July 2020

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