2016-2017 Tuition Payment Plan Agreement Form
Purpose of this form: Use this section if you are not able to pay your full tuition balance at the beginning of the semester. You must meet all due dates that are established by the school.


Terms and Conditions of Payment Plan
1. I agree to pay my tuition balance under the terms of my chosen payment plan.
2. I agree and understand that I am legally obligated to pay the full tuition even if I do not attend all classes.
3. I agree to pay all my installments on time, understanding that this means on or before the due date established.
4. I agree that the plan can’t be changed or canceled after it gets approved unless the change is agreed upon, in writing, by both parties.
5. I understand that there are no additional fees unless an established payment is late.
6. If I pay by check and it is returned for insufficient funds, then I will pay the penalty and late fee plus a $30 returned check fee.
7. Tuition payments received are first applied against the oldest outstanding amounts.
8. Payments sent by mail must be post-marked on or before the due date. I understand that I must also notify ArborVitae by email that the payment has been posted.

Payment Plan Options
Clover: Tuition is divided into four payments charged every other month.
Mugworts: Tuition is divided into eight payments charged every month.
Calendula: Tuition is divided into twelve payments charged every month.
This plan can only be signed up for prior to June 1st.
Impatiens: Tuition is divided into fifteen payments charged every month.
This plan can only be signed up for prior to March 1st.

Late Payment Policy

Penalty and Late fee:
o If I fail to pay the full due payment amount on or before the due date, I agree to pay late fee of 1.4% on the amount per week. The late fee is a percentage of the individual payment, not the tuition in its entirety. I understand that this late fee of 1.4% will be accumulating until the day I pay the total dues. This penalty and late fee will be added to my account starting from the day following the due date. Late fee will only apply to the tuition and installment fee and weekends and holidays are counted towards the late days.

o After 1 week of account delinquency I will be notified via email by the Accounting Office of penalty and late fee realization. I understand that failure to pay my dues could affect my student status.

Loss of eligibility for payment plan:
o If I fail to pay my installments on time on more than one occasion, then I may not be eligible for a payment plan the following year.

Readmission withholding:
o If I have any outstanding tuition balance, then I will not be able to enroll for future classes until I fulfill my obligation and I may risk my student status.

Removal from program:
o If I fail to pay my installments on time for two subsequent months, I understand that I may be asked to not come to class until I have made my payments. If this happens and I choose not to return to class, I am still responsible for paying the entirety of my tuition.

By filling out this form, I agree to and have read and understood all the above terms and conditions. I also recognize that it is my responsibility to adhere to the due dates and avoid any additional fees.

Last, First Middle
Your answer
Preferred name or nickname?
Your answer
Program Year
Part Time or Full Time?
Home Address: Street
Your answer
Home Address: Apartment or Suite
Your answer
Home Address: City and State
Your answer
Home Address: ZIP CODE
Your answer
Billing Address
Required if different from home address.
Your answer
Home Phone Number
Your answer
Cell Phone Number
Your answer
Email Address
Your answer
Payment Plan Option
Credit Card Issuer
Name on credit card
(If different than student's name.)
Your answer
Credit Card Number
Your answer
Credit Card Expiration Date
Your answer
Credit Card Security Code
Usually a 3 digit code on the back of the card or 4 digit code on front.
Your answer
Never submit passwords through Google Forms.
This form was created inside of ArborVitae School of Traditional Herbalism. Report Abuse - Terms of Service - Additional Terms