PDF 2019-2020 Housing License Agreement Financial Guarantor/Co ...

2019-2020 HOUSING LICENSE AGREEMENT FINANCIAL GUARANTOR/CO-SIGNER AGREEMENT

In compliance with the 2019 - 2020 Student Housing License Agreement all Licensees under eighteen years of age (18) are required to have a financial guarantor/co-signer. This guarantor/co-signer will bear shared financial responsibility for the cost of housing as determined by the Licensee's contract term and associated fees.

In accordance with Title V, Administrative Code 668.165 Housing and Residential Life will collect on charges due upon disbursement of a Licensee's financial aid award. Licensee and Guarantor/Co-Signer will be personally responsible for outstanding housing charges not paid in full by financial aid. It is the responsibility of the Licensee and the Guarantor/Co-Signer to ensure housing term charges have a zero balance upon conclusion of the contracted term.

In signing this agreement the designated guarantor/co-signer acknowledges that he or she has read the 2019-2020 Student Housing License Agreement and agrees to the terms, rate tables, policies and regulations specified in the License Agreement and the 20192020 Housing Administrative Polices and Regulations. These documents are viewable under the Forms and Publication page of the Housing website at .

Signature of the financial guarantor must be an original signature. The signed form can be scanned and emailed to housing@csustan.edu or faxed to (209) 667-3678. The original form can also be mailed to the address below. Please be aware that information in the form must be legible.

Guarantor/Co-Signer Information

First Name

(

)

Phone Number

Last Name

(

)

Cellular Phone #

Relationship to Licensee Guarantor Email Address

Mailing Address Student Information

City

State

Zip

Student Name

Student ID #

Guarantor/Co-Signer Signature

Contract Term: (Check One)

Summer A or B (5/25/19-8/10/19 or (6/1/19-8/10/19)

Year-Round A or B (5/25/19-5/24/20) or (6/1/19-5/24/20)

Fall Only Contract (8/18/2019-12/20/2019)

Academic Year (Fall: 8/18/19-12/20/19 & Intersession/Spring: 1/1/20-5/24/20)

Intersession/Spring (1/1/20-5/24/20)

Spring Only Contract (1/23/20-5/24/20)

As part of the online application process the licensee provided Housing and Residential Life with the contact information for his or her preferred Financial Guarantor/Co-Signer. In signing and submitting this agreement you are verifying the contact information he or she submitted. In providing this information the licensee authorized a student record information release (as required by FERPA) specifically as it pertains to the Licensee's financial account/status with Housing and Residential Life. Please note that without an information release from the student Housing and Residential Life will not disclose financial information to any party other than the designated Financial Guarantor/Co-Signer.

For Housing Use:

Entered in StarRez, date

Initials

Housing and Residential Life

One University Circle | Building 39 | Turlock, CA 95382 | T 209.667.3675 | F 209.667.3678 | csustan.edu/housing A proud member of the 23-campus California State University system.

ENGAGING ? EMPOWERING ? TRANSFORMING

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