Financial Responsibility : Welcome Packet Forms : Student Life

Acknowledgment of Financial Responsibility

The following information must be completed and the statement at the bottom must be signed and dated by a family member or other individual who is assuming responsibility for payment of the student account. The student’s signature is also required below. Students can only sign for themselves if they are determined to be “independent” by the Financial Aid Office.

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Student Information
Full Name:
Student ID Number:
Driver License Number:
Billing Information
Person Responsible for Payment:
Relationship to student:
Address:
City, State, ZIP:
Home Telephone:
Work Telephone:
Cell Phone:
E-mail Address:
Social Security Number:
Driver License Number:
Employer:
Employer Address:
City, State, ZIP:

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Online Welcome Packet Forms

Acknowledgment of Financial Responsibility