Fillable LAKE REGION STATE COLLEGE MONTHLY PAYMENT PLAN / (Lake Region State College)

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LAKE REGION STATE COLLEGE MONTHLY PAYMENT PLAN / (Lake Region State College)

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LRSC is an equal opportunity institution.
LAKE REGION STATE COLLEGE
MONTHLY PAYMENT PLAN / DEFERMENT REQUEST
The following contract serves two purposes. First, this contract allows for payment of your account balance at LRSC in four (4) monthly
installments. Second, if anticipated financial aid is expected to cover 100% of your account balance, this contract serves as a request for
payment deferment. If you have an approved third party governmental entity authorization on file in the Administrative Affairs providing for
100% payment of your account balance, you will not be required to complete this contract. You will receive a monthly account statement
showing the total amount of your balance. This contract cannot be used if any unpaid prior account balance exists.
Please note that the Payment Plan is subject to a $25.00 fee. If you have any questions, call (701) 662-1567 or (701) 662-1504.
Please complete the following items and mail the contract and the first payment by _____________________________to:
Lake Region State College
Administrative Affairs
1801 N. College Drive
Devils Lake, ND 58301-1598
1)
Account Balance (Tuition and Fees for semester)
This amount can be found via the LRSC website (www.lrsc.edu) by using the following navigation:
MY LRSC>Campus Connection>Sign In>Student Self Service>Finances>Account Inquiry >Charges Due
+
Estimated Bookstore Charges
+
2)
Financial Aid Anticipated through LRSC
(Grants, waivers, scholarships and loans only). If no aid was requested, enter "N/A" on this line.
Signature of Financial Aid Director:________________________________________________
minus
-
3)
Remaining Account Balance (Negative number indicates excess financial aid)
If $0 or less, fill out student name and address information and submit the form.
The contract will serve as a deferment and no fee will be charged.
=
4)
Monthly Payment Amount (Line #3 divided by four)
+
5)
Payment Plan Enrollment Fee (must be remitted with form)
+
$25.00
6)
Payment Due By
=
A late fee of 1.75% per month will be applied to account balances for payments 30 days past due.
Remaining payments (amount listed on Line 4) are due by the following dates:
(Amount due is 1/3 of your remaining account balance)
(Amount due is 1/3 of your remaining account balance)
(Amount due is your remaining account balance)
Payments can be made by cash, check, e-check, credit card, debit card or wire transfer. You may also pay online at the following navigation:
www.lrsc.edu>MY LRSC>Campus Connection>Sign In>Student Self Service> Finances>Pay Online Now
I will adjust my remaining payments if changes in anticipated Financial Aid and other Account Balance changes (usually caused by class drops
or adds) occur. I understand that a Transcript Hold will be placed on my account if my payment is late. My contract may be terminated for
late payments and cause the entire amount to be due.
STUDENT NAME AND ADDRESS INFORMATION
STUDENT NAME (LAST, FIRST, INITIAL) – PLEASE PRINT
STUDENT ID#
STREET ADDRESS
CITY
STATE
ZIP
EMAIL ADDRESS
STUDENT SIGNATURE
DATE
This payment plan is only for the current semester. Future semesters need a separate payment plan agreement.
January 29, 2020
January 29, 2020
for Spring 2020 TUITION and FEES
February 29, 2020
March 29, 2020
April 29, 2020
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LAKE REGION STATE COLLEGE MONTHLY PAYMENT PLAN (Lake Region State College)

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Completed 26 July 2020

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