Please print and complete this application, then mail it to:

ECSI c/o University of Scranton TPP Application
181 Montour Run Rd
Coraopolis, PA 15108

If you need help completing this form, please contact ECSI toll free at 866-927-1438.

Student Information

Student ID Number:
___________________________________________________________
Name (First MI Last):

 ___________________________________________________________
Address 1:

 ___________________________________________________________
Address 2:

 ___________________________________________________________
City/State/Zip:

 ___________________________________________________________
Email:

 ___________________________________________________________
Home Phone:

 ___________________________________________________________
Work Phone:

 ___________________________________________________________
Fax Phone:

 ___________________________________________________________
Cell Phone:

 ___________________________________________________________

Person Financially Responsible
Name (First MI Last):

 ___________________________________________________________
Address 1:

 ___________________________________________________________
Address 2:

 ___________________________________________________________
City/State/Zip:

 ___________________________________________________________
Email:

 ___________________________________________________________
Home Phone:

 ___________________________________________________________
Work Phone:

 ___________________________________________________________
Fax Phone:

 ___________________________________________________________
Cell Phone:

 ___________________________________________________________

Tuition Payment Plan
Select a plan: Select One
  Description Months Fee Start Date End Date Sign Up By
12 Month Plan (T1012) 12 $60.00 05/01/2010 04/01/2011 09/01/2010
10 Month Plan (T1010) 10 $60.00 07/01/2010 04/01/2011 09/01/2010
4 Month Fall Plan (T10F4) 4 $35.00 09/01/2010 12/01/2010 09/10/2010
4 Month Spring Plan (T10S4) 4 $35.00 01/01/2011 04/01/2011 01/10/2011

Anticipated Costs

Please include all fees including tuition, mandatory and optional fees, and deduct all financial aid. See the Tuition and Fee Schedule for pricing information.

Fall Amount to Finance: ____________
 
Spring Amount to Finance: ____________


Payment Plan Totals
  Fall Spring  
Total Amount to Finance:

 ______________________

 ______________________

 (Tuition and Fees minus Financial Aid & Payments)
Number of Months:

 ______________________

 ______________________

 (See Payment Plan Information for selected plan from above)
Monthly Payments:

 ______________________

 ______________________

 (Total Amount to Finance divided by number of months in selected plan)
Application / Participation Fee:

 ______________________

 ______________________

  
First Payment †:

 ______________________

 ______________________

 (Includes months past due and application/participation fee)
† - The application fee is due immediately. If the plan has not yet started, your first monthly payment is not due until the first due date.


Billing and Payment Information
Please sign me up for Electronic Bills
Electronic Bills replace paper bills, provide 100% of the same information, are archived for up to 10 years, and are available within minutes of preparation. When an electronic bill is prepared, you will receive an Email notifying you to return to our web site and review your billing statement.