Veteran's Request for Deferral of Tuition and Fees

Please read this form carefully and be sure you fully understand your obligation before signing and submitting.

Please don't fill out this input box.

Last Name*

First Name*

SUNY Schenectady Student ID#*

Semester*

Veteran's Chapter*

By signing below, the student agrees to the following conditions of this deferral.

I agree that failure to pay this deferral prior to the date indicated above will result in a hold being placed on my grade records, and I understand that I will not be permitted to register for any subsequent term until the amount of the deferral is paid in full. I further understand that SUNY Schenectady uses a collections agency and/or attorney as a means of outstanding debt collection. If it becomes necessary for SUNY Schenectady to submit my account for collection, I agree to be responsible for up to 30% of collection costs and/or attorney fees of up to 40%.

Digital Signature*Type your name

Date Signed*

If you know any of the following information, please include it. If not, the information will be filled out by Anna Westerman, the VA School Certifying Official. If you have any questions, please contact her in Elston Hall, Room 222. Phone: 518-381-1200 x1185 Email: westerap@sunysccc.edu

Total Tuition and Fees $

Total Financial Aid Applied (if known) $

Estimated VA Benefits $

Total Deferral Amount $

This deferral will be paid on or beforemm/dd/yyyy