StudentFinancialResponsibilityAgreement

Iunderstand and agree tothe followingtermsand conditions:PAYMENTOFTUITION, FEESANDCOSTS/PROMISE TOPAY

When I registerforanyclassat Universityof NewHaven,Incorporated(UNH) orreceiveanyservicefromUNH,I acceptfullresponsibilitytopayalltuition,feesand otherassociatedcostsassessedas a resultofmyregistrationand/orreceiptof servicesbythescheduledduedate,whichamountsthatareowedbymemaybeanobligation that is notdischargeable inbankruptcy.

If I dropor withdraw from someor allofthe classesforwhichI register, Iwillberesponsibleforpaying all ora portionoftuition andfees in accordancewiththe published tuition refundschedule thatI havereadat whichare incorporated hereinbyreference.

Myfailuretoattendclass orreceivea billdoesnotabsolvemeofmyfinancial responsibilityasdescribedabove.

DELINQUENTACCOUNT/COLLECTION

FinancialHold:If I failto paymystudent accountbill or anymoniesdueandowing UNH bythescheduled duedate,UNHwill place afinancial hold on mystudentaccount,preventing mefromregistering forfutureclasses,requestingtranscripts,orreceivingmy diploma.

LatePaymentCharge:If I fail to paymystudentaccountbill or any otheramountsdueandowing frommeto UNH by their scheduledduedates,UNH willassess amonthlylatepaymentand/orfinancecharges,which I agreeto pay,atthe rateof tenpercent peryear(ortherateprescribedbyConn.Gen. Stat.§37-3a(a)if lessthanten percentperyear)onthe pastdueportionofmystudent accountuntilmypastdueaccount is paid in full.

Collection Fees: IfI failto paymystudent accountbill or any other amountsdueandowingfromme to UNH bytheirscheduled duedates, I agreetoberesponsibleforpayingallreasonablecoststhat UNHmayincur in connectionwith the collection ofmyaccount,includingbut not limitedtoreasonableattorneys’fees,courtcostsand/orfeespaidtoa collectionagency. Collection fees can range from 25% up to 50% of an unpaid balance.Mydelinquent account maybereportedto one ormoreofthenationalcreditbureaus.

COMMUNICATION

Method ofCommunication: UNH usese-mail as anofficial methodofcommunicationwith

students. Therefore, Iam responsibleforreading thee-mailsthat IreceivefromUNH ona

timelybasis.

Contact: I authorizeUNH,and its agentsandcontractors,to contactme atmycurrentand anyfuturecellular phonenumber(s),email address(es)orwirelessdevice(s),including bytextormediamessage,regardingmystudentaccount(s),anydelinquencyon such account(s),any other debt IowetoUNH,or to receivegeneralinformation fromUNH.Byexecuting thisAgreement, IauthorizeUNH, anditsagents andcontractors,tousean automated telephonedialing system,and/oran artificial orpre-recordedvoicewhencallingmycellulartelephonenumberor sendingmea text messagesto contactmefor anypurpose,including advertisementsand telemarketingmessages,to mycellulartelephonenumber(s)providedtoUNH in theBannerstudent information systemand asupdated in accordancewiththe procedurenoted below. However, Imaysubsequently withdrawmyconsenttocallmycellular telephonenumberbysubmittingmyrequest in writing tothe Bursar’sOfficeor inwriting to the applicablecontractoror agentcontactingmeonbehalf ofUNH.

ByexecutingthisAgreement, I furtherconsent to thereceiptofe-mailmessages fromUNH, anditsagentsandcontractors,for all purposes,including messagesthatcontain commercialadvertisementsorthe promotionof acommercial productor service.

UpdatingContactInformation: I amresponsibleforkeepingUNH recordsupto datewithmycurrent physicaladdresses,emailaddressesand phonenumbersbyfollowing the procedureat incorporatedherein byreference.UponleavingUNH foranyreason, it ismyresponsibilitytoprovideUNH with updated contactinformation forpurposesofcontinuedcommunication regardinganyamountsthatremain due and owingtoUNH.

FINANCIALAID

GeneralConditions:Anyfinancialaiddescribedas “estimated” onmyFinancialAid Award doesnot representactualor guaranteedpaymentsbutis anestimateof theaidImayreceive if Imeet allofthe requirementsstipulatedbythat aid program.

My FinancialAidAwardiscontingent upon mycontinuedenrollmentand attendanceineachclass uponwhichmy financial aid eligibilitywascalculated. If I drop anyclass beforecompletion,my financial aid eligibilitymaydecrease,and someorall ofthefinancialaidawarded to memayberevoked.Ifsomeor allofmyfinancial aidisrevoked becauseI droppedor failed to attendclass, I agreetorepayall revoked aidthat wasdisbursed to myaccountandresulted in a creditbalancethatwasrefundedtome.

I agreeto allowfinancial aid I receivetopayany andall chargesassessedto my studentaccountat UNH such astuition,fees,campushousing andmealplans,student healthinsurance,parkingpermits,servicefees,fines, bookstorecharges, oranyotheramount, inaccordancewith thetermsof theaid.

FederalAid: Anyfederal TitleIV financial aidthat Ireceive,exceptforFederalWorkStudywages,will firstbeappliedtoanyoutstanding balanceonmyaccountfortuition,fees,roomandboard.Title IV financial aidincludesaidfrom thePellGrant,Supplemental EducationalOpportunityGrant(SEOG),DirectLoan,PLUS Loan,PerkinsLoan, andTEACH Grantprograms. IauthorizeUNHto applymyTitleIVfinancial aid to otherchargesassessedto mystudent accountsuch as studenthealthinsurance,parking permits,bookstorecharges,servicefeesand fines,andany othereducation related charges. Thisauthorizationwill remainineffectuntil I ceaseenrollment atUNHor Iwithdrawitatanytimebyfollowing theinstructionsat

Prizes,Awards,Scholarships,Grants:All prizes,awards,scholarshipsandgrantsawardedto mebyUNH will becredited to mystudentaccountand applied towardany outstanding balance.Myreceiptof aprize,award,scholarship orgrant isconsidered a financialresourceaccording tofederal TitleIV financialaidregulations and maythereforereducemyeligibilityforotherfederaland/orstatefinancial aid (i.e.,loans,grants,FederalWorkStudy),which, ifalreadydisbursed tomystudentaccount,mustbereversedandreturnedtotheaidsource.

METHOD OFBILLING

UNH useselectronicbilling(e-bill) as itsofficialbillingmethod.Therefore, Iam responsibleforviewingandpaying mystudent accounte-billbythescheduled duedate.Failuretoreviewmye-billdoesnotconstituteavalid reasonfornotpayingmybill ontime.E-billinformation isavailableat

BILLINGERRORS

Administrative,clericalortechnical billing errorsdonotabsolvemeofmyfinancial responsibilitytopaythecorrectamountof tuition,fees andotherassociated financialobligationsassessedasa resultofmyregistrationat UNH.

RETURNEDPAYMENTS/FAILEDPAYMENT AGREEMENTS

If a paymentmadeto mystudentaccount is returnedbythebankforanyreason,Iagreetorepaythe originalamountof thepaymentplus a returnedpayment feeof$30.00.Multiplereturnedpaymentsand/orfailuretocomplywith thetermsofanypaymentplanor agreement I sign withUNHmayresult in cancellationofmy classesand/or suspension ofmy eligibilitytoregisterforfutureclasses atUNH.

WITHDRAWAL

If I decideto completelywithdraw fromUNH, Iwill followthe instructionsat herein byreference.

PRIVACYRIGHTSRESPONSIBILITIES

UNH is boundbytheFamilyEducationalRightsandPrivacyAct(FERPA),which prohibitsUNHfromreleasing anypersonallyidentifiableinformationfrommyeducation recordwithoutmy

writtenpermission,exceptin thoseinstancesspecificallyallowed underFERPA.Therefore, if Iwant UNH toshareinformation frommyeducation record with someoneelse, Imustprovidewrittenpermissionbyfollowingtheprocedureoutlined at Imustsetupthird partyaccesstoePayinorder forthe Bursar’sOfficetodiscussmystudentaccount withsomeoneotherthanmyself at atanytimebyfollowingtheinstructions in thesameprocedure.

IRSFORM1098-T

I agreetoprovide mySocialSecuritynumber(SSN)ortaxpayeridentification number(TIN)toUNH upon request as required forInternalRevenueService(IRS)Form1098-Treportingpurposes. Iwill providemySSNor TINonan IRSForm W-9S, Request forStudent’sorBorrower’sTaxpayerIdentification Numberand Certification,oron suchotherdocumentrequestedby UNH. In addition, Iwillmaketherequisitecertifications, if applicable,required on such form ordocument.If IfailtoprovidemySSNor TINto UNH, Iagreeto payorreimburseUNH for anyandall finesassessedor imposedagainstUNH as aresult ofmyfailing toprovidethe requiredorrequestedinformation and/orcertification. I consent to receive my annual IRS Form 1098-T electronically from UNH.

STUDENT AGE

If I am younger thanthe applicable ageofmajoritywhen I executethisagreement, I agreethatsomeor alloftheservicesprovidedbyUNH are a necessityand I amcontractuallyobligatedtopaythemandmaynotvoidthis agreement.

ENTIREAGREEMENT

Thisagreementisthe entireagreement between meand UNH with respectto mypaymentobligationsto UNH and supersedesall priorunderstandings,representations,negotiations andcorrespondencebetweenmeand UNH relatedthereto otherthanany financialaid award whichis evidenced bya separateagreement. Thisagreement shall notbemodifiedor affectedbyanycourseofdealing orcourseof performance. Unless I amrequiredtoexecuteanotherstudentfinancial responsibilityagreement atthebeginning ofan academicyear or term, thisagreement willcovermycurrentand futureenrollmentatUNH.

Student Name:

Banner ID: 00

I understand and agree to the terms and conditions of the Student Financial Responsibility Statement.

Signature:Date:

Term: Fall 2016

Bursar’s Office

300 Boston Post Road ● West Haven, CT 06516 ● Tel: 203.932.7217● Fax: 203.931.6086

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