CGCE Delay Payment Submission

CGCE Student Delayed Payment Form

Westfield State University
College of Graduate and Continuing Education

DELAYED PAYMENT

Westfield State University offers a program for matriculated students that allows for payment of tuition over a period of time during the semester. Students must meet the following requirements:

Matriculation in a degree or certification program through CGCE.
Payment of the application fee (non-refundable).
Ability to pay total tuition and fees by published due dates.

Students must follow all regulations regarding withdrawals as stated in the College’s refund policy, and are responsible for total payment even if they withdraw before the end of the semester and regardless of grade. No student may apply for delayed payment who has been sent to a collection agent or placed in Administrative Withdrawal.

Students must complete the application and have it approved before they may register into courses. The application must be completed each semester. There is a late payment penalty charge if bills are not paid in full by the date of the final payment. Any account sent to collection is charged a 20% collection fee.

Instructions to apply: All students wishing to apply for the delayed payment plan must complete this application form each semester. A delayed payment fee of $100 is payable upon application and is non-refundable. After CGCE reviews the application, an email of approval/denial is sent to the student for the registration process. The application must be approved prior to registration.

Application deadlines are the first day of the term.

Payment due dates are as follows:

Fall Semester: First payment is due at time of registration, the Second payment is due the last Friday in September, Third Payment due last Friday of October, and Final payment is due the last Friday in November.
Spring Semester: First payment is due at time of registration, Second payment is due the last Friday in February, Third Payment due the last Friday in March, and Final payment is due the last Friday in April.
Summer Semesters: First payment is due at time of registration and Final payment is due at mid-point in term.
Please note that payment plans are not offered for the Winter Semester.


First Name	*
Last Name	*
Student ID	*
Email Address	*
Street Address	*
City	*
State (e.g. MA)	*
Zip Code	*
Home or Cell Phone (XXX-XXX-XXXX)	*

Semester Applying	*
Number of Credits you plan to enroll in.	*

Are you matriculated (in a degree program)?	*	Yes No
Which college?	*
Have you ever been placed on Administrative Withdrawal?	*	Yes No
Have you ever been sent to a Collection Agency? (If yes, please use box below.)	*	Yes No
If you answered yes to previous question, explain here.
Do you expect Financial Aid?	*	Yes No
If yes, what type of Financial Aid?	*

To the best of my knowledge the above statements are true. I agree to abide by the college regulations including those governing payment of tuition and withdrawal from class.	*	Yes
NOTE: NOTE: Grades will not be released nor can you register for the next semester until payment is made in full. Furthermore, any account sent to collection will be charged an additional 20% collection fee. Failure to pay by published due date will result in the denial of all future Delayed Payment Applications.
Relevant email may be copied /pasted into the field below or forwarded separately from this application form to ecamacho@westfield.ma.edu . Any documents that cannot be attached electronically may be forwarded to Estelle Camacho, Business Manager, 577 Western Avenue, Westfield, MA 01086. Please be aware that all details in your statement will be verified.
Explain here.
Attach additional documentation

Signature (Please type your full name here)	*
You will be notified of the outcome of your application via the email address that you provided above.