FINANCIAL SETTLEMENT AGREEMENT –FALL 2016

FINALIZE YOUR FALL 2016 REGISTRATION BY JULY 15, 2016SAVE $50!

STEP 1)Review the enclosed Estimate of Student Account for accuracy. Please remember that this estimate reflects

scholarships, but DOES NOT YET REFLECT LOANS for the upcoming semester.

STEP 2)In the spaces provided below please let us know how you plan on paying your remaining account balance by completingthis form. Don't forget that your registration is not complete until this financial agreement

has been submitted.

STEP 3)Mail, email or fax this form with your chosen payment method to the HPU Cashier/Student Accounts Office

by JULY 15, 2016, and the $50 registration fee will be waived!

STUDENT INFORMATION

STUDENT NAME (please print):

STUDENT I.D. NO.: DATE:

LOANS AND SCHOLARSHIPS

Expecting loans that are approved but not yet appearing on your "Estimate of Student Account"? Please list your approved loans for the Fall, including the loan program(s) and amount(s) you expect to receive. Remember that the actual loan amount disbursed will be reduced by up to 3% for lender fees. If you have confirmation that you are receiving other aid not on your account, list that as well.

  1. 3.
  1. 4.

DESIRED PAYMENT METHOD(please check one)

I expect to have no balance duebecause I have 100% approved financial aid after my loans.

I have just made payment arrangements through Tuition Management Systems (TMS) for the full remaining balance (after approved financial aid and estimated loans). TMS may be accessed via the web at via phone at 1-800-722-4867 or from HPU's website. Please indicate your selected TMS payment method as follows:

Credit CardA copy of my confirmation from TMS is enclosed

One-time bank draft

Monthly payment plan TMS ID No. is

I prefer HPU to process my payment manually for the full remaining balance (after approved financial aid and estimated loans) using the following method (please select one):

Check (enclosed)

Credit card (3% convenience fee added to payment) (Please call our office to process)

One-time bank draft (Please call our office to process)

AUTHORIZATION TO DISCLOSE INFORMATION (optional)

I hereby authorize the Cashier/Student Accounts Office of Howard Payne University to release and/or disclose any and all financial details of my student account to my parents, grandparents, guardian or spouse until further notice. I understand that without this consent, HPU cannot discuss my account with others. I also understand I may revoke this authorization at any time by notifying the Cashier/Student Accounts Office in writing.

STUDENT SIGNATURE: DATE:

TERMS OF AGREEMENT

I agree to pay the charges shown on the enclosed Estimate of Student Account, less anticipated loans, according to my desired payment method selected. I understand failure to return this agreement with the requested information may result in my ineligibility to save the $50 registration fee. I understand that the last day to withdraw and receive a partial refund of charges is September 8, 2016. I also understand failure to finalize my financial arrangements may result in my being dropped from classes, meal plan privileges and removal from campus housing. I understand if my account is turned over to a collection agency, I will be responsible for all costs associated with collection.

My signature indicates that I have read and agree to the terms outlined above.

STUDENT NAME (please print):

STUDENT SIGNATURE:

STUDENT ID NO.: DATE:

MAIL, EMAIL or FAX THIS COMPLETED FORM TO:

Cashier/Business

1000 Fisk StreetPhone (325) 649-8053 or (325) 649-8013

Brownwood, TX 76801Fax (325) 649-8971