SUNY
SCHENECTADY
COUNTY
COMMUNITY
COLLEGE
Student Name:
______________
_
EMT/CFR
Tuition Deferral
SCCC ID#
or
Last 4
of
SSN:
______
_
Sponsoring Fire House/ Agency/Employer:
_________________________
_
As a student enrolled at SUNY Schenectady County Community College (SUNY Schenectady), and in the event
that I
DO
NOT
meet the conditions below, I agree to pay SUNY Schenectady the sum
of$
_________
for
the Emergency Medical Technician (EMT)
or
Certified First Responder (CFR), ORIGNINAL
or
REFRESHER
course for the SPRING
or
FALL
20
____
term. I will be immediately responsible for payment
of
tuition and fees
associated with this course unless
I:
1.
Return a completed DOH-3312 Verification
of
Membership in
EMS
Agency Form (https://
www.health.ny.gov/forms/doh-3312.pd
f)
to the course instructor
on
or
before the first day
of
class OR
provide a signed letter from
my
employer stating the employer's intent to pay tuition and
fees.
2. Pass the Practical Skills Exam at the
end
of
the EMT /CFR course.
3.
Pass the required
NYS
Written Exam within 30 days from the
end
of
this course at SUNY Schenectady.
I understand that I am liable for the above tuition and
fees
to SUNY Schenectady for
my
attendance at SUNY
Schenectady including interest thereon. I will be additionally liable for any and
all
costs and disbursements associated
with collecting said tuition and
fees
from me including reasonable attorney fees.
I understand that if
my
sponsoring agency
or
employer has agreed to pay tuition and
fees
to SUNY Schenectady,
I will provide a signed letter stating that intent to pay which
is
subject to acceptance by SUNY Schenectady. In absence
of
a signed and accepted letter
of
intent to pay, I am responsible for all tuition and
fees.
I also understand that official
or
unofficial withdrawal from SUNY Schenectady does not relieve me
of
my
obligation to repay the
amount
due to the college and refunds shall be provided only in accordance with the course
refund/drop policy: (https://sunysccc.edu/About-Us/Workforce-Development-and-Community-Education/WFD-CE-
Course-Registration)
Student Signature:
_______________________
Date:
_____
_
SUNY Schenectady Student Business Office
Accepted By:
____________________________
Date:
______
_
Term:
___________________
Total Amount:
______________
_
rev. Summer 2019
