Conso
rtium Agreement between Southern Connecticut State University (SCSU)
AND
Name of HOST Institution: __________________________________
(College/university where course(s) will be taken)
Name of Student
SCSU ID
Number
Phone Number
Email
I understand that by entering into a consortium agreement I must:
1. Have a valid FAFSA on file at SCSU;
2. Be matriculated and enrolled in an approved Title IV eligible program of study at SCSU, and making Satisfactory Academic Progress
(SAP) as specified by the SCSU SAP policy;
3. Only register for courses at the HOST institution that have been approved AND are transferable toward my degree program;
4. Notify SCSU’s Office of Financial Aid and Scholarships immediately should my enrollment change at the HOST institution;
5. Have the HOST institution send official transcripts to the SCSU Registrar’s Office at the end of the semester;
6. NOT receive financial aid at the HOST institution;
7. Make payment arrangements with the HOST institution. I understand when financial aid is disbursed to SCSU, the Student
Accounts Office will refund any excess funds to me. There is no guarantee that entering into a consortium agreement will result in
excess funds.
By signing below, I authorize the host institution to release to SCSU information pertaining to this consortium agreement.
Student’s Signature
Date
Host Institution’s Student ID Number
Number of Registered Credits __________
Course Number ________
TO BE COMPLETED BY THE HOST INSTITUTION:
Enrollment Period: Starting: ___________ Ending: ___________
Course Name _________________________________________
Course Name _________________________________________ Course Number ________
Cost of Attendance
Tuition and Fees
Room and Board
Books and Supplies
Transportation
Personal Expenses
Other
TOTAL
The individuals authorized to sign below do hereby agree to the following:
1. SCSU considers the above-named student to be matriculated and enrolled in a Title IV eligible program, and approved to take
classes at another institution. SCSU will be responsible for monitoring Satisfactory Academic Progress (SAP) and other
requirements to be eligible to receive Title IV funds. All requirements listed in the U.S. Department of Education regulation 690.8
will be the responsibility of SCSU.
2. The HOST institution will verify enrollment status, and notify SCSU’s Office of Financial Aid and Scholarships should the student
withdraw from any classes.
HOST Institution Authorized Signature
Date
Name and Title
Email
SCSU Authorized Signature
Date
Name and Title
Email