Collin County Community College District Company Paid ...

Collin County Community College District

Registration for Company Paid Tuition & Fees

Company Name Contact Billing Address

Phone Number Fax Number

_______________________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________

Collin County Community College District (College) and __________________________________________ (Company) enter into an agreement whereupon Company agrees to pay the College for tuition, fees, books, and supplies as authorized by the Company. The period for which this agreement covers is indicated in the space below. Additionally, in the spaces provided, the costs for which the Company will be responsible are checked off and amounts indicated.

(1) Duration of Agreement: ____________________________________________________

(2) Costs paid by Company:

Tuition

Fees

Books

Supplies

(3) Maximum $ per student:

_________________________________

(4) Maximum $ per this agreement: _________________________________

Cancellations: If you drop a class 2 days before the first scheduled class day, 100% of the tuition is refunded. If dropped the day before or on the day of the first scheduled class day, 80% is refunded. There are no refunds issued after the first day of class. Please email Marcae Lee to drop a student.

It is understood that Collin County Community College District will invoice the Company and that payment is due upon receipt of invoice. When appropriate, attach a list of students, their corresponding social security number, course(s) in which to be registered, and amount to be paid by the Company for each student.

(5) Special Instructions:

(6) _________________________________ Signature of Company Representative

(7) ____________________________________ Signature of Collin College Representative

Title _________________________________ Date _________________________________

Title ____________________________________ Date ____________________________________

Fax completed forms to: 972.985.3727 For questions call 972.985.3762 or email Marcae Lee.

For Office Use Only:

Vendor ID

Third Party Billing/Contract Training Agreement

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Collin College requires the following information for course registration. Great care is given to safeguarding this sensitive information.

Student Name (Legal name: first, middle, last) Please print.

Social Security Number

Date of Birth

Phone Number CRN #

Course Name

Start Date of Class

Amount to be Paid

Third Party Billing/Contract Training Agreement

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