Alternate Payment Arrangement (APA) Arts & Science, Commerce, Engineering & Applied Science, Nursing, Law, Medicine, Education The personal information on this form is collected under the authority of the Royal Charter of 1841, as amended. The information collected will be used by the Office of the University Registrar to process your request as identified on this form. For more information, please contact the Office of the University Registrar, Records & Services, Queen's University, Gordon Hall. Telephone: (613) 533-6894. Tuition fees and the Student Assistance Levy (SAL) for fall and winter terms are due at the university by September 1st. Do not submit this form if you will pay your fees in full by September 1st. Students unable to pay fees in full by September 1st must complete and submit evidence of funding sources by August 15th in order to continue with registration. The submission will not be considered complete unless copies of funding source documents are provided with this form. Applicant Information Full Name: Student ID No.: Program/Plan: I am an international student and will pay my Fall Term tuition and Student Assistance Levy (SAL) charges on September 1st. . I request to defer my Winter Term tuition and SAL charges to January 31st. NOTE: If you select this option, submit this form without completing the remainder of the form. I am expecting funding but it may not be available to me until after September 1st so I request to defer tuition payment until September 30th. NOTE: Students accessing OSAP are not required to submit this form if your 2012-2013 OSAP amount is equal to or greater than your tuition fees. Your tuition payment due date will be deferred automatically to September 30th. However, if your OSAP entitlement does not fully cover your tuition, you must pay the difference by September 1st to ensure the due date for the amount covered by OSAP is deferred to September 30th. Step 1: Calculate Tuition fees due September 1st Enter the Tuition fees and SAL due September 1st (from SOLUS), in the box to the right: $ Step 2: List Sources of funds and their amounts Funding sources: Please enter any and all funding source(s) you are using to make alternate payment arrangements by entering information about the source and the amount of funds available in the box to the right. Government student financial assistance - from the province/state of: $ Enter the total amount of government student financial assistance available to you for the entire year, in the box to the right. Include funding source documents. Scholarship/awards external to Queen's - Name of the scholarship is: $ Enter the total amount of external scholarship and/or award monies available, in the box to the right. Include funding source documents. Funding agency - name of the agency is: $ Enter the total amount of tuition fee monies paid for by the agency, in the box to the right. Include funding source documents. The university will invoice the third party based on the documents provided. Other - I will pay the majority of my Tuition fees and SAL by September 1st. However, I will be short of the total required amount due so I am requesting to defer a portion of the payment to September 30th. Enter the amount you request to defer in the box to the right. Name of the source of the expected monies: $ How to submit your Alternate Payment Arrangements Arts & Science, Commerce, Engineering & Applied Science, Nursing, Law, Medicine, Education Step 3: Calculate Balance of fees due September 1st Subtract the total sources of funds available from “Tuition fees and SAL due September 1st” and enter the amount to the right. If the total sources of funds available is greater than the “Tuition fees and SAL Due September 1st”, enter zero. You must pay this amount to the university by September 1st. $ Due at the university by September 1st Step 4: Send this form with supporting documentation by August 15th Once you have completed this form, scan the form plus the source of funds document(s) into a PDF format, and e-mail them using your Queen's e-mail account to [email protected]. You will receive an e-mail confirmation of receipt of your documents. Please refer to the “Submitting Documents” section below to ensure you do not put your ongoing registration in jeopardy due to a submission error. Submitting documents Once you are satisfied that all the information is correct: 1. Save a copy of the completed form to your computer 2. Scan all supporting documentation 3. Attach all files (Alternate Payment Arrangement form plus supporting documentation) and submit via your Queen's e-mail address to [email protected] 4. Please ensure all supporting documentation is sent along with the application. DO NOT send supporting documentation without a completed Alternate Payment Arrangement form, or form without supporting documentation. A complete application includes this form and supporting documentation. Incomplete applications cannot be processed. 5. If your attachments exceed 10MB, please reduce the file size to ensure the e-mail gets through. Sources of funds: what to send to the university Government student financial assistance: •For all states or provinces (EXCEPT Ontario): scan a copy of the document advising of your assessment. •Ontario: Do NOT submit documentation. The university receives information about your student financial assistance directly from the Ontario Government. * If you have/or will be applying for a US William D. Ford Federal Direct Loan please contact Terry Stover (Student Awards) to make appropriate arrangements ( [email protected] ; 613-533-6000 ext. 74565 ). Scholarship/awards external to Queen's: •Scan a copy of any letter or agreement that states clearly how much you will receive in award monies and when the monies will be paid. Include that letter in your Alternate Payment Arrangement submission. Third-party payee (funding agency) • Scan a copy of any letter or agreement that states clearly how much the agency will pay towards your education. Include that letter in your Alternate Payment Arrangements submission. •The university will invoice the third party based on that documentation. Other •Scan a copy of any letter or statement that shows clearly how much you will receive and when the monies will be paid. For example, a final summer paycheque. Include that letter with your Alternate Payment Arrangements submission. Print Form for your records