2019-2020 Student Title IV Financial Aid Consortium Agreement
Klamath Community College is an equal opportunity educator and employer
The above student is enrolled in the following at _____________________________ HOST
Institution
Name of Course Course Number Credit Hours Total Cost
1. ___________________________ ________________ ____________
2. ___________________________ ________________ ____________
3. ___________________________ ________________ ____________ $__________
All pending disbursements for this term have been cancelled at the HOST Institution.
________________________________ __________________________ ______________
Signature, Financial Aid Official Title Date
___________________________ @ .
Phone Number Email Address
Klamath Community College Academic Advising
KCC credit hours: _______ + Host credit hours: _______ = Total credit hours: _______
Student’s current MAJOR ____________________________________________________
As the student’s Academic Advisor, I certify that the courses at the HOST Institution that the
student is enrolled in are applicable to their KCC program of study. The student has not
previously earned credit for these courses at KCC, nor has the student previously transferred
these credits to KCC. I have confirmed with the student that their current major and degree
program are accurate in the college records.
______________________________________________ ______________________
Academic Advisor Signature Date
_____________________________ @ .
Phone Number Email Address
Comments:
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
Please return this form to:
Klamath Community College Phone: (541) 882-3521
Financial Aid Office Fax: (541) 880-2250
7390 S. 6
th
Street www.klamathcc.edu
Klamath Falls, OR 97603 Title IV School Code: 034283