Current Temp:
59 °F
Weather Station
Print This Page
TIPP Form
Untitled 1

Berkshire Community College
Att: Student Billing
1350 West Street
Pittsfield MA  01201

                 Tel. #: (413) 236-3042   
                 studentbilling@berkshirecc.edu                        http://www.berkshirecc.edu/  

Three Installment Payment Plan (TIPP) Form
FALL 2013
  

    

Step 1:  Student (please print)

 

Name:

 

SSN or Student ID:

Last

First

 

Address:

 

Telephone:

City, State, Zip:

 

Employer:

 

Telephone:

Employer Address:

 

City, State, Zip:

 

Step 2:  Co-Signer – Required (please print)

 

Name:

 

SSN:

Last

First

 

Address:

 

Telephone:

City, State, Zip:

 

Employer:

 

Telephone:

Employer Address:

 

City, State, Zip:

 

Terms of Agreement

  1. STUDENT  agrees to make payment to Berkshire Community College (hereinafter referred to as “College”) for semester charges in accordance with the payment schedule set forth in part (III) of the Three Installment Payment Plan (hereinafter referred to as “Plan”)
  2. STUDENT agrees to submit a completed application. A CO-SIGNER is  required for all TIPP participants. If STUDENT is under the age 18 the CO-SIGNER  must be the STUDENT'S parent or legal guardian. CO-SIGNER must be over 18 years  of age.
  3. STUDENT agrees to pay as Installments Two or Three all additional  tuition fees incurred after  the  approval of this Plan
  4. STUDENT agrees to make all payments by the due date. Late payments are subject to a $50 late  fee. Failure to meet the conditions of the Plan shall result in a hold of  the STUDENT'S record, and may result in the STUDENT'S account being turned over  to collection. STUDENT shall be obligated for all collection and/or legal cost  incurred.
  5. STUDENT agrees to pay $30  non-refundable administrative fee for participating in this Plan.
  6. STUDENT agrees to confirm his/her balance with the College's Business  office prior to making final payment.
  7. STUDENT agrees to abide by the Add/Drop, Withdrawal, and Refund  Policies and all other pertinent policies set forth by the College and/or its  Board of Trustees.
  8. CO-SIGNER agrees that if STUDENT fails to meet the conditions of this  Plan, CO-SIGNER will be held fully responsible for the outstanding obligation of  this Plan, including collection and legal fees.

Step 3:  Calculate Total balance Due Less Deductions

 

The following calculation is designed to assist you in computing your installment payments:

 

 I.

Initial Charges (See balance due on the upper right hand corner of your bill)

 

$

II.

Deductions:

 

Financial or scholarship aid that has not already been credited to your bill.

($               )

 

Health Insurance $1603 if charged-Complete Waiver On-line

$9.00 MASSPIRG Contribution if charged-Complete Waiver Form 

($               )

 

Total Deductions

($               )

 

Net balance due after deductions             

($                 )

 

 

Step 4:  Calculate Payments, Include Fee

 

III.

Remit Payments to:

 

Berkshire Community College
Attn: Student Billing
1350 West Street
Pittsfield, MA 01201

Installment One (must be included with this form)         

Non-Refundable $30 Payment Plan Fee

    $30.00

1/3 of the net balance,

Remit first payment: (due Friday, August 9, 2013)

+ $__________

   

Installment Two   

Remit 1/3 of the original net balance,
(due Friday, September 9, 2013)                                                                     

  $

Installment Three    

Remit unpaid balance in full, 
(due Friday, October 4, 2013)                                                   

  $

Total Payments 

  $

               

Step 5:  Signatures with Dates

 

Certification I have read and understand the Terms of Agreement of TIPP and agree to the conditions as set forth herein. I have read and understand the Refund Policy.

 

 

 

 

Student Signature

Date

Co-Signature

Date

 

 

****************************** Student Billing Office Approval ******************************

 

 

 

Signature of Authorized Person

Date

Invoice#___________________ $30.00 TIPP Fee Charged to Student’s Account