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Rappahannock Community College College Name Office of Financial (Rappahannock Community College)

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Rappahannock Community College College Name
Office of Financial Aid Address
12795 College Drive
Glenns Virginia 23149
Student Information (to be filled out by the student)
First Name Last Name MI EMPLID
Academic Year Term
SSN
The Financial Aid Office at ________________________________________(host institution) agrees to enter into a
Consortium Agreement with the Financial Aid Office at Rapphannock Community College (home institution) for the
student and academic period listed above. This student has permission from the home institution to take a course
(or courses) at the host institution. Said course/courses will transfer to the home institution to be applied to the
student's degree or certificate, as verified on page two of this form by the student's advisor.
The items of agreement are:
Rappahannock Community College, as the home institution, agrees to process the student's financial aid, including
the enrollment status and cost of attendance at the host institution; and
, the host institution, agrees not to process any
financial aid awards for the student for the academic term indicated above; and
The above named student will be responsible for payment to the host institution in accordance with their guidelines
and payment policies.
Student Portion (to be filled out by the student)
Instructions/Important Information:
1) Decide which courses you need to take at the host school. 5) FOLLOW UP with the host school. They should
2) Complete the first page of this form. certify this form after the add/drop period ends.
3) Take the form to your advisor for approval of the course(s) 6) RCC will process any aid increases after
as part of your RCC degree/certificate (see page two). receiving this form from the host school.
4) Send this form to the host school's Financial Aid Office for You will receive a revised award notice at that time
appropriate signatures (see page two).
if your eligibility changes.
Curriculum (Major) Reason course(s) cannot be taken at RCC
Advisor Name
Credit Hours Credit Hours
Responsibility:
I understand that if for any reason my financial aid is reduced, I am fully responsible for my Host Institution debts.
Student Signature Date
EMPLID
1)
2)
3)
Consortium Agreement
Home Institution
Host Institution
Course Name
Name(s) of Courses you plan to take at the Host Institution:
Between RCC (as the Home Institution) and the Host Institution (as listed below)
Course Name
4)
5)
6)
RCC Advisor Portion (Students do NOT complete this section.)
Upon consulting the student's academic transcript, I find that the course(s) above are fully creditable toward the student's
stated degree/certificate goal. List any exceptions below - if none, write none.
Advisor Name (Print) Advisor's Signature
Phone Number Date
Host Institution Financial Aid Office's Portion - Cost of Attendance (Students do NOT complete this section.)
Please use actual costs after the end of the add/drop period.
Tuition for ________________ credits at $_______________per credit hour = $_________________.
Fees (if any) $___________________
Host Institution Financial Aid Office's Representative Name (Print) Financial Aid Office's Representative Signature
Phone Number Date
Host Institution Registrar's Office Portion - Enrollment Certification (Students do NOT complete this section.)
I certify that the student involved has registered for the course(s) listed in the student portion of this form,
for the 20 semester beginning on __________________ and ending _________________.
List any exceptions below - if none, write none.
Host Institution Registrar's Office Representative Name (Print) Registrar's Office Representative Signature
Phone Number Date
Note: Please complete and mail back to RCC as soon as possible after the end of the add/drop period.
*********************************************************************************************************************************************
Signature Date
Coordinator of Financial Aid & Veteran Services
Rappahannock Community College
Vickisha D. Harris
Total Cost
(For Home Institution Signature)
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Completed 27 July 2020

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