FLORIDA PREPAID COLLEGE PLAN - Justice Admin

FLORIDA PREPAID COLLEGE PLAN

ADD LOCAL FEE PLAN ? TUITON DIFFERENTIAL FEE PLAN ? DORMITORY PLAN

IMPORTANT! YOU MAY ENROLL IN THE LOCAL FEE, TUITION DIFFERENTIAL FEE AND/OR DORMITORY PLAN NOW, BUT YOU WILL BE SUBJECT TO THE PRICES EFFECTIVE OCTOBER 2008.

You may use this form to add a local fee plan, tuition differential fee plan, a dormitory plan, or all three to an existing Florida Prepaid tuition plan for the same beneficiary (student). The account owner (purchaser) of the plan being added must be the same account owner listed on the existing tuition plan. Please refer to the Enrollment Kit for information about program options, features and policies. For information, call 1-800-552-GRAD (4723) or visit . To enroll online, visit

1. PLANS

Select the type of plan(s) you want to add and a payment option for each plan. You may select a different payment option for each plan.

If You Have One of These Tuition Plans

Tuition Plan: Covers registra-

tion fee, which includes tuition, 4-Year University Tuition

building, capital improvement and financial aid fees, charged

Plan (120 University

by Florida's public universities Undergraduate Credit Hours)

and community colleges.

2+2 Tuition Plan

(60 Community College/60 University Undergraduate Credit Hours)

2-Year Community College Tuition Plan

(60 Community College Hours)

You Have These Plan Options

May only be purchased for a child who is currently in the eighth grade or younger

Local Fee Plan

4-Year University Local Fee Plan (120 University Undergraduate Credit Hours)

Covers only the student activity and service, health and athletic fees imposed by state universities, and student activity and technology fees imposed by state community colleges.

J Lump-Sum Payment Plan J 5-Year Payment Plan

(55 monthly payments)

J Monthly Payment Plan

(Monthly until child starts college)

Tuition Differential Fee Plan

4-Year University Tuition Differential Fee Plan (120 University Undergraduate Credit Hours)

Covers the supplemental fee charged to a student for instruction provided by a public university in the state pursuant to Section 1009.24 (15) Florida Statutes.

J Lump-Sum Payment Plan J 5-Year Payment Plan

(55 monthly payments)

J Monthly Payment Plan

(Monthly until child starts college)

Dormitory Plan

Select a University Dormitory Plan

2+2 Local Fee Plan (60 Community 2-Year Community College

College/60 University Undergraduate Credit Local Fee Plan (60 Community

Hours)

College Hours)

J Lump-Sum Payment Plan J 5-Year Payment Plan

(55 monthly payments)

J Monthly Payment Plan

(Monthly until child starts college)

J Lump-Sum Payment Plan

(Only payment option available)

2+2 Tuition Differential Fee Plan (Only 60 University Undergraduate Credit Hours)

J Lump-Sum Payment Plan J 5-Year Payment Plan

(55 monthly payments)

J Monthly Payment Plan

(Monthly until child starts college)

(Not available)

Select a 2+2 Dormitory Plan

Covers the cost of a standard, double-occupancy, air-conditioned dormitory room.

J 1-Year Plan (Two Semesters) J 2-Year Plan (Four Semesters) J 3-Year Plan (Six Semesters) J 4-Year Plan (Eight Semesters)

Select a University Dormitory Payment Plan

J 1-Year Plan (Two Semesters) J 2-Year Plan (Four Semesters)

Select a 2+2 Dormitory Payment Plan

(Not available)

J Lump-Sum Payment Plan J 5-Year Payment Plan

(55 monthly payments)

J Monthly Payment Plan

(Monthly until child starts college)

J Lump-Sum Payment Plan J 5-Year Payment Plan

(55 monthly payments)

J Monthly Payment Plan

(Monthly until child starts college)

FP 07-08 OSADD/2.5M

2. CURRENT ACCOUNT INFORMATION

Provide your current Florida Prepaid College Plan account information here:

Prepaid Tuition Plan Account Number ? REQUIRED

Beneficiary (Student) Social Security Number ? REQUIRED

--

--

Account Owner (Purchaser) First Name

MI Last Name

Account Owner (Purchaser) Social Security Number ? REQUIRED

--

--

If the account owner mailing address, telephone number and/or e-mail address has changed, please update below:

Account Owner Mailing Address (COMPLETE STREET ADDRESS INCLUDING APARTMENT # OR P.O. BOX)

City

Home Telephone

--

--

Account Owner E-Mail Address

State

Zip Code

--

Work Telephone

--

--

3. APPLICATION FEE

The application fee is nonrefundable. If you are applying for multiple plans, please mark each plan you are applying for ($10 application fee for each plan). Make your check or money order payable to: Florida Prepaid College Plan

Local Fee Plan: $10

Tuition Differential Fee Plan: $10

Dormitory Plan: $10

4. ACCOUNT OWNER AUTHORIZATION AND SIGNATURE

By signing below, I certify that all the information provided on this form is true, complete and correct.

Signature of Account Owner (Purchaser)

Date

Please return the completed form and check or money order for the application fee to: Florida Prepaid College Board, P.O. Box 6448 Tallahassee, FL 32314-6448.

Within four weeks, you will receive written confirmation that your form has been received.

NOTE: If your application is received after January 31, 2008, a local fee plan, tuition differential fee plan or dormitory plan may only be added if the beneficiary is entering the eighth grade or below during the 2008-09 school year, and you will be subject to plan prices effective in October 2008.

OFFICE USE: Check/Money Order #____________________ Check/Money Order $____________________ Related AP______________ Other______________ Tracking #4

FP 07-08 OSADD/2.5M

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