How many of the credit hours which the student is taking at the Host School are applicable to their program at Lourdes University? Please list the course(s) the student is taking at the Host School which are applicable to their program at Lourdes University: Registrar’s Signature Section III To be completed by the Host School Financial Aid Office – Will the student receive financial aid at your institution? Yes No □ □ If STOP. Do not complete the remainder of this form. Please sign the form and return it to “Yes”, the student. If please complete the remainder of this form: “No”, Dates of Enrollment under this Agreement Number of Credits to Tuition and Fees $ Other (please $ specify) Total $ Lourdes University’s Office of Financial Aid will be notified by Host School if the student withdraws from any classes taken under this Agreement. Yes No □ □ Other School - Financial Aid Officer’s Signature Please print or type name Telephone No. / E-mail Address Date The student’s funds will be disbursed directly to the student according to cash management regulations, using the term dates your institution has provided. It will be the student’s responsibility to pay the balance due to your institution. Please return this form to: Attention: Callie Zake, Phone: 419-517-7487 Lourdes University Office of Financial Aid 6832 Convent OH 43560 (419) 824-3732 phone (419) 517-8866 fax
How many of the credit hours which the student is taking at the Host School are applicable to their program at Lourdes University? Please list the course(s) the student is taking at the Host School which are applicable to their program at Lourdes University: Registrar’s Signature Section III – To be completed by the Host School Financial Aid Office Will the student receive financial aid at your institution? □ Yes □ No If “Yes”, STOP. Do not complete the remainder of this form. Please sign the form and return it to the student. If “No”, please complete the remainder of this form: Dates of Enrollment under this Agreement Number of Credits to Tuition and Fees $ Other (please specify) $ Total $ Lourdes University’s Office of Financial Aid will be notified by Host School if the student withdraws from any classes taken under this Agreement. □ Yes □ No Other School - Financial Aid Officer’s Signature Please print or type name Telephone No. / E-mail Address Date The student’s funds will be disbursed directly to the student according to cash management regulations, using the term dates your institution has provided. It will be the student’s responsibility to pay the balance due to your institution. Please return this form to: Attention: Callie Zake, Phone: 419-517-7487 Lourdes University Office of Financial Aid 6832 Convent OH 43560 (419) 824-3732 phone (419) 517-8866 fax
Consortium-Agreement-10-2-18.docx