Student Financial Responsibility and Contact Consent Form- 2017/2018
All students are required to demonstrate acknowledgement of their financial responsibility when they register for classes at Coker College. Please read the following information and click the corresponding boxes to acknowledge that you have read the form.
Email address *
First Name *
Your answer
Last Name *
Your answer
ID Number *
Your answer
PAYMENT OF FEES/PROMISE TO PAY
I agree that when I register for any class or receive any service from Coker College that I accept full responsibility to pay all tuition, fees and costs assessed as a result of my registration and/or receipt of services. I further agree that my registration and acceptance of these terms constitutes a promissory note (i.e., a financial obligation in the form of an educational loan as defined by the U.S. Bankruptcy Code at 11 U.S.C. §523(a)(8)) in which Coker College is providing me educational services, deferring some or all of my payment obligation for those services.

I agree that if I drop or withdraw from some or all of the classes for which I register, I will be responsible for paying all or a portion of tuition and fees in accordance with the published tuition refund schedule in Coker College’s Academic Catalog, which can be located at https://coker.edu/academics/office-academic-records/academic-catalogs. I have read the terms and conditions of the published tuition refund schedule and understand those terms are incorporated herein by reference. I further agree that my failure to attend class or receive a bill does not absolve me of my financial responsibility as described above.

I agree that administrative, clerical or technical billing errors do not absolve me of my financial responsibility to pay the correct amount of tuition, fees and other associated financial obligations assessed as a result of my registration at Coker College.

Acknowledgement *
Required
DELINQUENT ACCOUNT/COLLECTION
Financial Hold: I agree that if I fail to pay my student account bill or any monies due and owing Coker College by the scheduled due date, Coker College will place a financial hold on my student account, preventing me from registering for future classes, requesting transcripts, or receiving my diploma.

Collection Agency Fees: I agree that if I fail to pay my student account bill or any monies due and owing Coker College by the scheduled due date, and fail to make acceptable payment arrangements to bring my account current, Coker College may refer my delinquent account to a collection agency. I further agree that I am responsible for paying the collection agency fee which may be based on a percentage at a maximum of forty percent of my delinquent account, together with all costs and expenses, including reasonable attorney’s fees, necessary for the collection of my delinquent account. Finally, I agree that my delinquent account may be reported to one or more of the national credit bureaus.

Acknowledgement *
Required
IRS FORM 1098-T
I agree to provide my Social Security number (SSN) or taxpayer identification number (TIN) to Coker College upon request as required by Internal Revenue Service (IRS) regulations for Form 1098-T reporting purposes. If I fail to provide my SSN or TIN to Coker College, I agree to pay any and all IRS fines assessed as a result of my missing SSN/TIN.

I consent to receive my annual IRS Form 1098-T, Tuition Statement, electronically from Coker College. I understand that if I do not consent to receive my Form 1098-T electronically, a paper copy will be provided. I understand that I can withdraw this consent or request a paper copy by contacting Coker College’s Office of Student Accounts.

Acknowledgement *
Required
COMMUNICATION AND CONTACT
Method of Communication: I agree that Coker College may use e-mail as an official method of communication with me, and that therefore I am responsible for reading the e-mails I receive from Coker College on a timely basis.

Contact: I authorize Coker College and its agents and contractors to contact me at my current and any future cellular phone number(s), email address(es) or wireless device(s) regarding my student account(s)/loan(s), any other debt I owe to Coker College or to receive general information from Coker College. I authorize Coker College and its agents and contractors to use automated telephone dialing equipment, artificial or pre-recorded voice or text messages, and personal calls and emails, in their efforts to contact me. Furthermore, I agree that I may withdraw my consent to call my cellular phone by submitting my request in writing to the Office of Academic Records or in writing to the applicable contractor or agent contacting me on behalf of Coker College.

Updating Contact Information: I agree that I am responsible for keeping Coker College records up to date with my current physical addresses, email addresses, and phone numbers by following the procedure provided by the Office of Academic Records, which can be found at http://webadvisor.coker.edu/WebAdvisor/html/ChangeofStudentnameaddresstypeorlocation.pdf. The linked procedure is incorporated herein by reference. Upon leaving Coker College for any reason, it is my responsibility to provide Coker College with updated contact information for purposes of continued communication regarding any amounts that remain due and owing to Coker College.

Acknowledgement *
Required
ENTIRE AGREEMENT
I agree that if I am younger than the applicable age of majority when I execute this agreement that the educational services provided by Coker College are a necessity, and I am contractually obligated pursuant to the “doctrine of necessaries.”

This agreement supersedes all prior understandings, representations, negotiations and correspondence between the student and Coker College, constitutes the entire agreement between the parties with respect to the matters described, and shall not be modified or affected by any course of dealing or course of performance. This agreement may be modified by Coker College if the modification is signed by me. Any modification is specifically limited to those policies and/or terms addressed in the modification.

Acknowledgement *
Required
A copy of your responses will be emailed to the address you provided.
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