STUDENT ENROLLMENT AGREEMENT FALL 2012 STUDENT INFORMATION NAME: _________________________________________ SSN or Student ID #___________________ ADDRESS: ___________________________________________________________________________ CITY/STATE/ZIP: _____________________________________________________________________ TELEPHONE #’S: H:_______________________ C: _____________________ W:_________________ E-MAIL: _____________________________________________________________________________ PROGRAM INFORMATION INITIAL APPLICATION ____/____/____ PROGRAM (circle one): BTh min) BA AA TODAY’S DATE: ____/____/____ (in Religious Studies) Certificate (general / music / assoc START DATE for this PROGRAM: _________________ ANTICIPATED END DATE: _______________ NEW STUDENT: ( ) YES ( ) NO STATUS: ( ) FULL-TIME ( ) PART-TIME COURSE REGISTRATION COURSE CODE COURSE TITLE INSTRUCTOR DAYS TIMES ROOM CREDIT HOURS RATE $180 $180 $180 $180 $180 $180 TUITION TOTAL REGISTRATION FEE TECHNOLOGY FEE $75 $75 AMOUNT LATE REGISTRATION FEE COURSE CHANGE FEE PROMISSORY NOTE FEE APPLICATION FEE $75 $25 $35 $40 TOTAL TUITION AND FEES I understand that ALL fees are NON-refundable except as otherwise provided herein. _____ Initials Schedule of Charges * Application Fee — One Time $40.00 Tuition Per Credit Hour $180.00 Registration Fee (non-refundable) $75.00 Late Registration Fee (additional) $75.00 Auditing Fee $120.00 Technology Services Fee $75.00 *All charges are subject to change Online Course Fee $30.00 Course Change Fee $25.00 Transcript Fee $15.00 Graduation Fee $125.00 Promissory Note $35.00 International Student Fee $250.00 All tuition and fees are due by August 17, 2012 unless other arrangements have been made in writing and approved by the appropriate Simmons official. Examples of other arrangements are Promissory Notes (see Payment Plan), and evidence of external funding such as PELL grants, Vocational Rehabilitation allowances or Veterans benefits. Payment Plan┼ For the student who is unable to pay the total cost of registration and tuition by the due date, the following payment plan is available. A student may pay one-third of the total fees by August 17, and divide the remaining charges in three equal payments with the installments being due and payable on or before the fifth (5th) of each succeeding month. All student accounts must be kept current and all accounts must be paid before the students’ grades will be posted in a given semester. Any student who fails to remain current on their account will not be allowed to register for classes for the following semester. Financial Penalties┼ Students whose accounts are not paid by the established semester deadlines may be subject to financial penalties. Students with unpaid account balances will be placed on Financial Hold by the Bursar's Office. Students placed on Financial Hold become ineligible for further registration and transcripts will not be released until the student account is paid in full. A late payment fee of $50.00 may be assessed when student accounts are not paid by the last day to drop/add for the semester. A return payment fee of $25.00 may be assessed when payment is not honored by the bank on which it was drawn. If restitution is not made within 10 days of notification, the student may be subject to financial penalties and/or legal action. Debtors who do not make satisfactory payment arrangements on their past due accounts may have their accounts placed with a billing service. If not paid through the billing service, the unpaid account may be forwarded to a collection agency. It is the policy of the College that unpaid accounts will be assessed the costs and expenses of collection, including attorney fees. Refund Policy for Cancellations Prior to the First Day of Classes Rejection: An applicant rejected by the college is entitled to a refund of all monies paid. Cancellation: An applicant who provides written notice of cancellation prior to the first day of classes is entitled to a refund of all monies paid, excluding non-refundable fees. Tuition Reductions┼ When a student officially withdraws from the College or from any course, or courses, for which hourly tuition rates apply, tuition charges will be adjusted according to the TUITION REDUCTION SCHEDULE. The full amount of tuition charges for the semester will be due 3 unless the withdrawal occurs during the Tuition Reduction period. Course fees, special fees and laboratory fees are reduced only with 100% tuition reduction. TUITION REDUCTION SCHEDULE┼ August 17 is the last day to initially register for the term. After you register for a term, you may drop/add through the withdrawal deadlines dates. The last day to add is also the last day to delete a course from your record. After that date, a grade of "W" is assigned for all withdrawals. Fall Semester 2012 Registration Period (Cancellation Refund Policy in effect) STUDENT ORIENTATION (9:00 AM-11:00 AM) FACULTY ORIENTATION (11:00AM-1:00 PM) Late Registration Dates Classes Begin Last Day to Initially Register 1ST CONVOCATION Last Day to Withdraw with 90% Tuition Credit Labor Day: No classes Last Day to Add Courses Last Day to Withdraw with 80% Tuition Credit Last Day to Withdraw with 50% Tuition Credit Last Day to Withdraw REGISTRATION FOR SPRING SEMESTER THANKSGIVING DAY HOLIDAY Last Day of Classes Final Exams Aug. 20– Dec. 6 April 25 – Aug. 17 Aug. 16 Aug. 16 Aug. 20-24 Aug. 20 Aug. 24 Aug. 27 Aug. 30 Sept. 3 Sept. 5 Sept. 11 Sept. 19 Oct. 8 Nov. 12, 2012-Jan 11, 2013 NOVEMBER 21-22 Dec.6 Dec. 10-13 Withdrawal Procedure: A. A student choosing to withdraw from the college after the commencement of classes is to provide a written notice to the Registrar. The notice must include the expected last date of attendance and be signed and dated by the student. B. If special circumstances arise, a student may request, in writing, a leave of absence, which should include the date the student anticipates the leave beginning and ending. The maximum period of a leave of absence is 180 days. The withdrawal date will be the date the student is scheduled to return to Simmons College of Kentucky from the leave of absence but fails to do so. C. A student may be determined to be withdrawn from the institution if the student misses six consecutive instructional days or seven consecutive instructional hours and all of the absences are unexcused. D. All refund requests must be submitted within 45 days of the determination of the withdrawal date. ┼ All sections bearing this symbol ┼ are based on policies published by the University of Louisville. 4 Return of Title IV Policy The Financial Aid Office is required by federal statute to recalculate federal financial aid eligibility for students who withdraw, drop out, are dismissed, or take a leave of absence prior to completing 60% of a payment period or term. The federal Title IV financial aid programs must be recalculated in these situations. The calculation must be performed even if the student has completed 60% of the payment period to show that the school determined that the student withdrew. If a student leaves the institution prior to completing 60% of a payment period or term, the financial aid office recalculates eligibility for Title IV funds. Recalculation is based on the percentage of earned aid using the following Federal Return of Title IV funds formula: Percentage of payment period or term completed = the number of days completed up to the withdrawal date divided by the total days in the payment period or term. (Any break of five days or more is not counted as part of the days in the term.) This percentage is also the percentage of earned aid. Clock hour institutions must use clock hours scheduled to be completed as of the withdrawal date divided by the total hours in the payment period. Funds are returned to the appropriate federal program based on the percentage of unearned aid using the following formula: Aid to be returned = (100% of the aid that could be disbursed minus the percentage of earned aid) multiplied by the total amount of aid that could have been disbursed during the payment period or term. If a student earned less aid than was disbursed, the institution would be required to return a portion of the funds and the student would be required to return a portion of the funds. Keep in mind that when Title IV funds are returned, the student borrower may owe a debit balance to the institution. If a student earned more aid than was disbursed to him/her, the institution would owe the student a post-withdrawal disbursement which must be paid within 120 days of the date the institution determined that the student withdrew. Refunds are allocated in the following order: · Unsubsidized Federal Stafford Loan · Subsidized Federal Stafford Loan · Federal Perkins Loan · Federal Parent (PLUS) Loan · Federal Pell Grant · Federal Supplemental Opportunity Grant · other Title IV assistance · other state · private and institutional aid · the student Veterans Refund Policy Any person receiving educational assistance from the Veterans Administration (VA) shall be entitled to a pro-rated refund of any charges and/or fees. The refund shall equal 5 the pro-rated cost of the incomplete course. (Students receiving VA entitlements should contact their VA representative for further financial assistance.) NOTICE TO STUDENT: 1. Do not sign this agreement before you have read it or if it contains any blank spaces. 2. This agreement is a legally binding instrument when the agreement is accepted, signed, and dated by the authorized official of the college. Both sides of the contract are binding. Read both sides before signing. 3. You are entitled to an exact copy of this agreement and any disclosure pages you sign. 4. This agreement and the college catalog constitute the entire agreement between the student and the college and supersede any oral statements or representations made by/between college and student. 5. The college does not guarantee job placement to graduates upon program completion or upon graduation. 6. The college reserves the right to cancel or reschedule any course when the number of students registered is too small. 7. The college reserves the right to terminate a student’s training for unsatisfactory progress, nonpayment of tuition or failure to abide established standards of conduct. 8. The college does not guarantee the transferability of credits to a college, university or institution. Any decision on the comparability, appropriateness and applicability of credit and whether they should be accepted is the decision of the receiving institution. STUDENT ACKNOWLEDGMENTS: 1. I hereby acknowledge receipt of the college’s catalog dated __________________, which contains information describing programs offered, and equipment/supplies provides. The college catalog under which I was admitted to the program is included as part of this enrollment agreement, and I acknowledge that I have received a copy of this catalog. I understand that the college provides only one paper catalog to each student, but that a current catalog is available to me on the Simmons College of Kentucky website, and hard copies are available for my review in the Simmons Library and other administrative offices. ______ Student initials 2. I have carefully read and received an exact copy of this enrollment agreement. ______ Student initials 3. I understand that the college may terminate my enrollment if I fail to comply with attendance, academic, and financial requirements or if I fail to abide by established standards of conduct, as outlined in the college catalog. While enrolled in the college, I understand that I must maintain satisfactory academic progress as described in the college catalog and that my financial obligation to the college must be paid in full before a certificate or degree may be awarded. ______ Student initials 4. I understand that the college does not guarantee job placement to graduates upon program completion or upon graduation. ______ Student initials 5. I agree to the use of electronic communications for my account information. I understand that I may request a paper copy of any communications addressed to or intended for me. ______ Student initials 6. I understand that all tuition and fees are subject to change. 6 ______ Student initials 7. I understand that complaints, which cannot be resolved by direct negotiation with the college in accordance to its written grievance policy, may be filed with the Kentucky Council on Postsecondary Education at 1024 Capital Center Drive, Suite 320, Frankfort KY 40601. All student complaints must be submitted in writing. ______ Student initials 8. I have received the Student Handbook, and I agree to comply with the policies of Simmons College of Kentucky. ______ Student initials 9. I understand that Simmons College of Kentucky requires students to participate in Christian service, to attend Simmons Convocations and orientation/ informational sessions, to cooperate with the college’s pursuit of excellence by taking assessment exams and surveys, writing essays and participating in other projects as needed. I agree to complete all such requirements. ______ Student initials 10. I understand that it is my responsibility to initiate and follow through on communication with faculty and administration on matters pertaining to my admission, registration, academic status, intention to graduate, and medical issues or other concerns. I commit to check the Simmons announcement boards, my mail and my telephone/email messages regularly for announcements concerning events and policies. I agree to communicate clearly and promptly with the appropriate authorities on all issues relating to my studies. ______ Student initials 11. I, _____________________________________(print your name), understand that Simmons College of Kentucky reserves the right to take photos in public sites, including within the college, and to use these photos appropriately and without prior permission for the legitimate promotion of the college. I hereby authorize Simmons College of Kentucky to use photographs taken of me at any and all college or collegerelated functions in college publications, to identify me by name, and to offer the photographs for use or distribution in other non-college publications, electronic or otherwise, without notifying me. I waive any right to inspect or approve the finished photographs, and I waive any right to monetary payment, now and forever, for the use of the photographs. I agree to release and hold the college harmless for publishing and distribution of the photographs from and against any claims, damages or liability arising from or related to the use of the photographs. I understand that if I do not wish my image to be used as described above, I may sign a form requesting that use of my image be limited to internal use such as library cards and student files. Signature: ____________________________________ Date: _________ CONTRACT ACCEPTANCE I, the undersigned, have read and understand this agreement and acknowledge receipt of a copy. It is further understood and agreed that this agreement supersedes all prior or contemporaneous verbal or written agreements and may not be modified without the written agreement of the student and the College Official. I also understand that if I default upon this agreement I will be responsible for payment of any collection fees or attorney fees incurred by Simmons College of Kentucky. My signature below signifies that I have read and understood all aspects of this agreement and recognized my legal responsibilities in regard to this contract. 7 __________________________________________________ Signature of Student Date ___________________ REPRESENTATIVE’S CERTIFICATION: I hereby certify that there have been no verbal or written agreements or promises other than those appearing on this agreement. __________________________________________________ ___________________ Signature of College Official Date 8