Fillable PURDUE NORTHWEST Consortium Agreement UNIVERSITY (Purdue University Northwest)

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PURDUE NORTHWEST Consortium Agreement UNIVERSITY (Purdue University Northwest)

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STUDENT NAME: ____________________________________ PUID: ______________________
PURDUE
UNIVERSITY
®
NORTHWEST
_____________________________________________________ ________________________________
OFFICE OF FINANCIAL AID
Consortium Agreement
A written agreement between eligible institutions so that a student can continue to receive Federal Student Aid funds while studying at a school
other than the “HOME” school (the school that will grant the student’s degree or certificate)
DEADLINE: the end of the first week of classes for the semester the Consortium is being requested.
Purdue University Northwest (the HOME institution) and the HOST institution listed below are entering into a consortium agreement according
to federal Title IV regulations for the student listed. It shall be enforced only for the enrollment period indicated and pertain only to the courses
enrolled at the HOME institution and approved for completion at the HOST institution. This Consortium Agreement can only exist between
eligible schools and applies only to courses that will count toward the student’s degree or certificate program at Purdue University Northwest (the
HOME institution). Approved credit hours taken at the HOST institution are included in the student’s Satisfactory Academic Progress review at
the HOME institution.
STEP 1: Completed by the Purdue University Northwest (PNW) Student – Review and Sign
Home Institution: Purdue University Northwest (where the student is enrolled in a degree or certificate program)
Host Institution: ______________________________________ (where the student is taking part of his/her program
requirements through a consortium agreement)
Total Credit Hours enrolled at PNW (HOME Institution): ________ HOST Institution: _________
Enrollment Period (Semester) at PNW: Start Date: ___________ End Date: _______________
Reason course(s) are not being taken through PNW: __________________________________________________
Attach additional documentation if necessary
Purdue University Northwest (PNW) Consortium Agreement Policy
The Office of Financial Aid at PNW will process financial aid based on this Consortium Agreement for PNW students admitted in a non-degree
status at another institution provided the following conditions and responsibilities are agreed upon by both the HOST institution and the HOME
institution and the Consortium Agreement is returned to PNW with STEP 1 completed:
1. The student’s PNW academic advisor certifies that the course(s) taken at the HOST institution apply toward the student’s PNW degree
program (student must be degree seeking).
2. The student must be enrolled for at least 3 credit hours at PNW, have a cumulative GPA of 2.00 and not have a “hold” on any account.
3. The student must be meeting Satisfactory Academic Progress requirements at the HOME institution.
4. Course work must transfer from the HOST institution to PNW and must be a C- or better grade or future consortium agreements will be
denied.
5. The student agrees to send a transcript of classes taken at the HOST school upon completion or notify PNW of withdrawal from HOST school
classes. Failure to send a transcript will result in a hold placed on the student’s account, preventing receipt of financial aid.
6. The Satisfactory Academic Progress policy at the HOME institution is applied to course work for which the student is enrolled during the
Consortium period at both the HOME institution and the HOST Institution.
7. The HOME institution will assume responsibility for processing and disbursement of aid as well as refunds and/or repayments to the Title IV
programs, if necessary. The student may use refunds to pay outstanding charges at the HOST institution and/or other educational expenses.
Certification Statement (read and sign below)
I certify that I have read the instructions and policies listed in STEP 1. I understand the process and my responsibilities with respect to this
Consortium Agreement. I acknowledge that all expenses and charges incurred at the HOST institution are my responsibility for payment and not
the responsibility of PNW. This agreement is not approved until ALL Steps are completed, the original form has been turned into the PNW Office
of Financial Aid and I have received an email to my PNW email from the PNW Office of Financial Aid that this Consortium Agreement has been
approved. Course work listed for the HOST institution must be completed with a grade of C- or better in order to be accepted as transfer credit by
PNW. By signing this form, I agree to the terms and required processes for this agreement.
Student’s Signature Date
Hammond Campus
2200 169
th
Street Hammond, IN 46323
(219) 989-2301 fax (219) 989-2141
Westville Campus
1401 S. U.S. Hwy. 421 Westville, IN 46391
(219) 785-5460 fax (219) 785-5653
finaid@pnw.edu pnw.edu
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___________________________________________________ ____________________________
___________________________________________________ ____________________________
___________________________________________________ ______________________________
__________________________________________________________ ___________________ ____________________
________________________________________________________ ___________________________________
STEP 2: Completed by the student’s Academic Advisor at Purdue University Northwest (PNW)
Instructions: Complete and return this form to the student. List course(s) from the HOST institution that will count toward the
student’s degree program at Purdue University Northwest (PNW) and sign the certification statement below.
Course #1 ____________________________________________ Credit Hours: ________________
Course #2 ____________________________________________ Credit Hours: ________________
Course #3 ____________________________________________ Credit Hours: ________________
I certify that upon receipt by PNW of an official transcript from the HOST institution showing completion of the course work listed
in this section that the student will use the credit hours toward PNW degree/graduation requirements. Prerequisite courses for
PNW course work that will not be accepted or transferred, as college level course work cannot be included.
Academic Advisor’s Signature Date
Academic Advisor’s Name (please print) Phone Number
STEP 3: Completed by the HOST institution’s Financial Aid Administrator
Enrollment Period: __/__/__ to __/__/__ Student’s Cost of Attendance for enrollment period:
Credit Hours enrolled for period: _____ $_________ Tuition & Fees
List classes enrolled with credit hours for each class: $ _________ Books & Supplies
Course #1: ____________________________ Cr. Hours: _____ $ _________ Room & Board
Course #2: ____________________________ Cr. Hours: _____ $ _________ Miscellaneous
Course #3: ____________________________ Cr. Hours: _____ $ _________ Total Cost of Attendance
I certify that the HOST institution will provide enrollment and student budget (cost of attendance) information in accordance with existing
HOST institution policies and procedures; will notify PNW’s Office of Financial Aid if the student drops classes or completely withdraws
from the HOST institution; and agrees NOT to provide federal or state financial aid to this student for the enrollment period specified.
HOST Institution Financial Aid Administrator’s Signature Date
HOST Institution Financial Aid Administrator’s Name (please print) Phone Number FAX Number
STEP 4: Completed by the HOME Institution (PNW) Office of Financial Aid
PNW Credit Hours _________ + Host Credit Hours ________ = Total Credit Hours: ___________
NOTES:
I verify that all the steps and requirements for this Consortium Agreement have been completed. If approved the student financial awards will be based on
the combined credit hour enrollment and non-duplicated Cost of Attendance (COA) of the HOST and HOME institutions.
PNW Office of Financial Aid Official Date
Office Use Only RRAAREQ: ________ CONSRT (R) Term: _____________
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PURDUE NORTHWEST Consortium Agreement UNIVERSITY (Purdue University Northwest)

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Completed 21 July 2020

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