LONG ISLAND UNIVERSITY PAYMENT PLAN ENROLLMENT

LONG ISLAND UNIVERSITY PAYMENT PLAN ENROLLMENT FORM
Student Name (print): ___________________________________________ Student ID #: ______________________________
I elect to participate in the Long Island University Payment Plan selected below. Upon signing the Payment Plan
Agreement Form and submitting my first payment plus the $35 non-refundable participation fee, I agree to make
payments to Long Island University on or before the due dates listed on my signed Agreement Form. I agree that
accounts with unpaid balances after each installment due date shall be considered in a state of default. No grades
or records shall be released and I shall not be eligible for future registration until such time as my financial obligation
has been paid. All costs and expenses incurred by Long Island University in the enforcement of collecting past due
accounts, including, without limitation, collection costs and attorney’s fees, shall be my responsibility.
YOU MUST COMPLETE AND RETURN THIS FORM TO ENROLL IN A LONG ISLAND UNIVERSITY PAYMENT PLAN
Payment Plan Type: ■ Monthly* (■ 6-Month ■ 5-Month ■ 4-Month) ■ Term** (■ 3 Installments ■ 2 Installments)
*Must be selected prior to the start of the term.
**May be selected at or after the start of the term.
Student Signature: ____________________________________________________________ Date: _______________________
Please Detach and Return with Payment