FOR SBH FINANCE OFFICE USE ONLY:

Please allow:

NAME ID NUMBER

To clear finance for the / Quarter / Year. The student must clear all other holds.

SU/F/W/SP (e.g. 2014-15)

(Please check one)

Student has holds or outstanding items to clear.

OR

No holds or outstanding items that need to be cleared (except financial clearance).
Classes have been entered on Banner.
Special Instructions to Student Finance: / Projected balance is / $
Prior balance is / $ / *

*If the student has FEDERAL financial aid, the prior balance cannot exceed $200.00.

(Please check one)

No payment required at this time.

OR

Standard payment arrangement permitted (100% of past balance, plus 1/3 of current balance, plus $100 late
payment fee due for clearance, with remaining 2/3rds due during the first two months of the quarter).

OR

Other payment arrangement, not to exceed the length of the term (Please specify below).

CLEARANCE POLICIES:

  1. Complete the bottom portion of this form and email it as an attachment to Shannon .
  1. Once approved you will be copied on the final approval email. Next, follow step 3.
  1. Student MUST contact Student Finance to request clearance in person or by phone (909) 558-4520, option #5.Email requests from students for clearance will not be accepted.
  1. The student will be charged a $100 or $200 late registration fee if financial clearance is not obtained by the deadline. Please see the registration portal for deadline dates and times.
  1. A $100 late payment fee will be charged if the student does not pay-in-full at registration.In addition, any unpaid balance may be subject to finance charges (10% APR).

TO BE COMPLETED BY STUDENT REQUESTING FINANCIAL CLEARANCE:

Name: / ID Number:
Financial Clearance for: / TERMSUFWSP / Quarter / YEAR20102011201220132014201520162017201820192020 / Year. Student must clear all other holds.

SU/F/W/SP (e.g. 2010-11)

Department / Program: / Social Work & Social Ecology
Expected Completion Date: / TERMSummerFallWinterSpringYEAR2010201120122013201420152016201720182019202020212022202320242025
Student balance is / $
Prior balance is / $ / * If student has FEDERAL financial aid,
prior balance cannot exceed $200.
I agree that if I do not use the funds as agreed upon, the school has no responsibility and they will not
clear me for the following quarter.
Payment arrangement (Please specify below).