Deferred Payment Plan Request
Kuyper College permits the payment of college expenses on an installment plan via its Deferred Payment Plan. The Deferred Payment Plan is available to students who are in good standing and desire to pay their fees in either three (3) or four (4) installments. In order to request the deferred payment option, please complete this form. A $35.00 Deferred Plan Set-up Fee will be assessed if approved and  it will be added to your first payment.

This form must be submitted prior to the start of classes each term in order to be considered.
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If approved, all payments are in equal installments and are due the first business day of the month.  The due dates are as follows:
I agree to a  service charge of $35.00 to be levied for each payment not received on the first business day of the month(s) specified. The college reserves the right to withhold grades, transcripts, and the ability to register if the account is not paid in full according to the terms agreed upon.
I would like to request a (three or four) payment plan (select one below). *
Required
Student's Name: *
Please enter your Student ID# or the last four digits of your Social Security # below: *
Student's Email Address: *
Responsible party (may be the student) *
Permanent address of responsible party (may be student) *
Phone number of responsible party (may be student) *
The above payment plan is requested for which term? *
Should it become necessary to collect past due accounts through the services of a third party, all the collection costs associated with the collection of the unpaid balance will be added to the account and become the responsibility of the undersigned.
By entering your name, the student affirms that they have read and understand the Deferred Payment Plan terms as stated above and request that Kuyper College enroll me (the student identified above) in the Deferred Payment Plan as specified above. The student will be notified within five business days of the disposition of this request. *
The typed signature, email and address entered below indicates agreement with the terms of this agreement. This may be signed by the responsible party or the student. *
For Official Use
Reviewed by: ___________________________    Date: _____________
  ⃣  Approved      ⃣  Not Approved

Student Notified: ________________________    Date: ____________

Recorded in SIS: Date: __________________    By: ______________

Copy added to student’s Financial Aid file:  Date:____________________  By: _____________

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