REGISTRATION FORM - Kettering College

Registration Form
 New
 Continuing
 Late Admit
Term/year ____________
Name __________________________________________________________
KC ID # ______________________________________________________________
Address ________________________________________________________
Home phone ____________________________________________________
Mobile phone ________________________________________________________
Method of Payment (Check all that apply)
 Payment in Full
 Payment Plan (*Payment Plan Agreement must be signed below)
First payment by:  cash / check / credit card
 financial aid
 Financial Aid
 Sponsor Payment (JTPA, BVR, VA, Chap 31, Conference Subsidy, PSEO Option B,
KC employee/dependent, Employer Tuition Assistance)
*Payment Plan Agreement
I understand and agree to abide by the terms of the Payment Plan. I agree to contact the Student Finance Office if for some unforeseen reason I am unable
to make a payment. I understand that if I break the agreement, the total amount owed is due immediately. I understand that I will not be allowed to register
for the following semester if the account is not paid in full. I authorize Kettering College to investigate my credit and employment history.
Students Receiving Veterans’ Benefits or State Aid
Kettering College sends enrollment certificates to the Department of Veterans Affairs at the end of the refund period. I understand that VA or the State of
Ohio may not provide funding for courses that are not required for my anticipated degree.
Taxpayer Information for IRS Reporting Requirements
The information being collected is mandated by the federal government in order to fulfill reporting requirements of the Taxpayer Relief Act of 1997. I
understand that the information on this form will be reported to myself and the Internal Revenue Service at the end of the calendar year.
Credit Account Agreement and Disclosure Statement (on back or attached)
I understand and agree to the Credit Account Agreement and Disclosure Statement terms on the reverse side of this Registration Form. By signing this
Registration Form, I am acknowledging the receipt of the Kettering College Credit Account Agreement and Disclosure Statement and agree to be bound by
the terms therein.
Student Signature
Required signatures
Advisor _________________________________________________________
Student Finance Office __________________________________________________
NOTE: These signatures must be present prior to submitting this form to the Records Office.
Course ID
Course Title
Total Credit Hours Registered
I understand that I am registering for the above listed courses.
Student Signature
Date ______________________________
This agreement states the terms of your Kettering College
account (the "Account"). "You" and "your" mean each of the
undersigned, jointly and severally. "We," "us" and "our" mean
Kettering College, Kettering, Ohio.
You can use your Account to purchase goods and services in
connection with your education at Kettering College.
You authorize Kettering College to apply all purchases, fines, and
fees, including, but not limited to, tuition, room, board, books,
supplies, library fines, parking fines, testing, and graduation fees
to your Account. You have the right to rescind this authorization
at any time.
You promise to pay for all purchases and other charges on your
Account when due including, but not limited to, tuition, room,
board and any other expenses incurred by you and charged to
your Account by us, whether incurred by you or any other person
authorized by you. On the billing date for any school term for
which you are enrolled or any time thereafter, we will charge your
Account with all expenses, including, but not limited to, tuition,
room, board and other charges.
To get your "Adjusted Balance," we take the balance you owed at
the end of the previous billing cycle, add any new charges,
subtract any payments and credits during the present billing
Each month we will send an email notice to current students
reminding them that their current statement is available to view
online. Former students who have not attended during either of
the prior 2 semesters will be sent a paper statement via mail at
the beginning of each month unless you don't owe us any money
or your Account has been has been turned over to a collection
agency. The statement will show information about your
Account, including the amount you must pay and when it is due.
You agree to notify us promptly if you change your address.
If your Account is not paid in full at the time of withdrawal or
graduation, 1/5 of the net amount is due by the 20th of the
following month. The remaining amount will be billed monthly
thereafter with four more payments due. No transcript or
diploma will be released by us nor will you be permitted to finalize
registration for classes for subsequent semesters if the Account
balance is not paid in full.
If you pay us with a check, a money order, or other item, and it is
returned to us unpaid for any reason after we try to collect it, you
agree to pay us a returned check charge of $28.00.
There is no collateral as security for the amount you owe us on
your Account.
Immediate payment of the full amount that you owe us (including
your agreement to pay all attorneys' fees, up to 33% added to the
debt for collection fees of any collection agency, court costs, and
any other expenses that may be incurred in enforcing our rights
under this agreement to the extent permitted by law) shall be
required, without further action by or notice from us, and we may
cancel your Account:
If you fail to make the Minimum Payment as defined
which is due or break any of the other terms of this agreement or
any other agreement you may have with us;
If you cease to attend Kettering College for any reason;
If you give us false information about yourself or your
If we have reason to believe you will not be able to
repay us;
If you become subject to Title 11 of The United States
Code (Bankruptcy Code); or
Upon the death of the student.
We can delay or waive any of our rights without losing them
You authorize us to make or have made such credit investigation
as we deem appropriate, to evaluate your credit, personal or
financial standing and/or employment.
Except where specific written notice is required by law, we can
cancel your Account anytime in person, by phone or written
notice sent to you. You can cancel your Account by notifying us
in writing. If your Account is cancelled by you or by use you will
have to pay us the full amount you owe us, including amounts
which have not been billed to your account yet.
We can change the terms of this agreement at any time. When
required to give you notice, we will notify you by posting any
changes in our offices unless federal or Ohio law requires us to
give you any additional notice. You agree that changes will apply
to charges made prior to any change as well as to new charges.
Your Account is also subject to applicable Ohio and federal law.
If the law makes part of this agreement void, the other terms will
still be enforceable
Shared Drive, KCMA, Faculty Staff Public, Forms from the Registrar’s Office, 2016 Forms, Updated 4/14/16