Klamath Community College
Student Title IV Financial Aid Consortium Agreement
Home Institution: The Institution that you are receiving financial aid from and that will be
awarding your degree when all course work is completed.
Host Institution: The Institution that you are taking course work from that will apply towards
your degree at the Home Institution. The Host Institution does not provide financial aid.
This form is to assist Klamath Community College financial aid students who wish to enroll at
more than one institution during a term. A student who is concurrently enrolled at both Klamath
Community College (Home Institution) and the Host Institution will have his/her enrolled credits
combined to determine enrollment status for financial aid disbursement. This form is for
students who want KCC to be their Home Institution. Only the Home Institution may disburse
financial aid funds for the term.
Student Section:
Choose the academic Term that you plan to be co-enrolled. Note: student must complete a
new Consortium Agreement every term.
Summer 2019 Fall 2019 Winter 2020 Spring 2020
____________________________________ _____________________
Student’s Name Student ID Number
__________________________________________________________________________
Name of Host Institution
__________________________________________ _______________________
Student Signature Date
Submit to the HOST Institution for completion (attach copy of registration):
Please initial each of the following terms and conditions:
____
I am enrolled in a minimum of 6 credits at Klamath Community College.
____
The course I am enrolled in at the host institution is not offered at Klamath Community
College.
____
I have cancelled all aid awarded by my HOST Institution for the term of co-enrollment.
____
A copy of my course registration at the HOST Institution is attached NOT a billing statement.
____
The course I am registering for at the HOST Institution is a 100 or 200 level course. Courses
above 200 level will not be included in financial aid eligibility.
____
An academic advisor has approved my HOST coursework as applicable to my Klamath
Community College degree plan, and completed the advisor certification on the back of this
form.
____
I understand that I can only receive financial aid from one institution each term.
____
I understand that my HOST credits and grades will be treated in the same manner as all other
courses taken at Klamath Community College, and will be subject to Klamath Community
College’s Standards of Satisfactory Academic Progress.
____
I will submit an official transcript to Klamath Community College’s Financial Aid Office at the
completion of the term, and I understand that future funding will be postponed until the official
transcript is received.
____
I understand that I am responsible for paying all tuition, fees, & other incidental charges at my
HOST Institution by the first Friday of the term with the Cashier 541-880-2237.
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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
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