Form

Trine University - Payment Agreement Form (FOR NEW STUDENTS ONLY)
Please complete the following information:
Payment Options - Please select One*

Self-Pay Deferment for Employer Assistance (Must complete Employer Assistance Form) Financial Aid (Grants/Loans) – Must complete FAFSA application to determine eligibility Other
Link to Employer Assistance Form
If Other - Please indicate method below:
Student ID Number
Full Name*
First Name Last Name

Address*

Home Phone Number*
- Area Code Phone Number
Cell Phone Number
- Area Code Phone Number
Campus
Your E-mail Address*
Please click the radio button to agree to each of the following questions:
I will not be permitted to register while I have a past due balance.*

I Agree
I alone am responsible for full payment of all tuition and fees incurred during any academic year. This includes any loss of financial aid.*

I agree
I may be held responsible for reasonable collection fees, attorney fees, and court costs, without relief of evaluation and appraisement law, to collect an outstanding balance.*

I agree
My transcripts and/or diploma will remain on HOLD as long as I have an outstanding financial obligation to the University.*

I agree
Nonpayment and/or nonattendance does not constitute withdrawal from classes.*

I agree
By submitting this online form, I agree to abide by the rules and regulations of the student handbook and also the Trine University catalog under which I entered.*

I agree
Should be Empty:

Trine University - Payment Agreement Form (FOR NEW STUDENTS ONLY)