Whitworth University Logo

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

ECSI c/o Whitworth University 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 (T0812) 12 $45.00 06/01/2008 05/01/2009 05/25/2008
10 Month Plan (T0810) 10 $45.00 08/01/2008 05/01/2009 07/25/2008
9 Month Plan (T0809) 9 $45.00 09/01/2008 05/01/2009 08/25/2008
4 Month Fall Plan (T08F4) 4 $35.00 09/01/2008 12/01/2008 08/25/2008
3 Month Fall Plan (T08F3) 3 $35.00 10/01/2008 12/01/2008 09/25/2009
4 Month Spring Plan (T08S4) 4 $35.00 02/01/2009 05/01/2009 01/25/2009
3 Month Spring Plan (T08S3) 3 $35.00 02/01/2009 04/01/2009 01/25/2009

Student Status

To pay an amount other than the standard tuition amounts listed, please enter that amount below in the section entitled "Non-Standard Tuition."

Tuition: Select One
Academic Year ($27,100.00)
One Semester Only ($13,550.00)
Per Credit ($1,130.00) x ________________ (Number of Fall/Spring Credits) = ________________
 
Housing: Select None or One
Single - Academic Year ($5,144.00)
Single - One Semester Only ($2,572.00)
Double - Academic Year ($4,144.00)
Double - One Semester Only ($2,072.00)
Theme House - Academic Year ($4,244.00)
Theme House - One Semester Only ($2,122.00)
Boppell - Academic Year ($4,600.00)
Boppell - One Semester Only ($2,300.00)
 
Meal Plan: Select None or One
Meal Plan A - Academic Year ($3,556.00)
Meal Plan A - One Semester Only ($1,778.00)
Meal Plan C - Academic Year ($3,310.00)
Meal Plan C - One Semester Only ($1,655.00)
Off-Campus Meal Plan - Academic Year ($1,330.00)
Off-Campus Meal Plan - One Semester Only ($665.00)
Boppell - Academic Year ($2,330.00)
Boppell - One Semester Only ($1,165.00)
 

Mandatory Fees: (Select all that apply)
Mandatory Student Fees - Academic Year ($320.00)
Mandatory Student Fees - One Semester Only ($160.00)
Health Insurance ($240.00)

Optional Fees: (Select all that apply)
Additional Fees Private Music Lessons: 1 Credit (per Semester) ($250.00)
Private Music Lessons: 2 Credits (per Semester) ($500.00)
Overload Fee - 1 credit over 17.0 credits ($735.00)
Overload Fee - 2 credits over 17.0 credits ($1,470.00)
Overload Fee - 3 credits over 17.0 credits ($2,205.00)
Overload Fee - 4 credits over 17.0 credits ($2,940.00)
Overload Fee - 5 credits over 17.0 credits ($3,675.00)

Insurance Waiver

Health insurance is required and cannot be waived unless the student has other health insurance. The Whitworth Health Insurance Waiver form must be completed or the insurance will not be waived. See Confirmation Billing information for Waiver form. If you have completed the Whitworth Health Insurance Waiver form, check "Waive Health Insurance" below to remove the health insurance fee from the TPP application.

Do Not Waive Health Insurance
Waive Health Insurance (-$240.00)

Financial Aid:
(as it appears on your award letter. Do not include Work Study.)

Your award letter includes loan amounts offered to you. All loans require paperwork which must be completed to apply for the loan funds. Include in the calculation below only those loans for which you intend to apply. If you do not intend to apply for loans offered on your award letter, do not include them below. If you have questions about loan types or amounts, please contact the Financial Aid Office at Whitworth University. If you apply for loans that are denied, you are responsible for the amount of the loan. You may contact ECSI and adjust your contract by that amount.

For 12-Month Payment Plan, you may estimate your anticipated 2008-09 Financial Aid award. Your total budget will be adjusted after your financial aid award is finalized for the coming year.


Federal Stafford Loan:
______________________
Federal Plus Loan:

 ______________________
All Other Loans:

 ______________________
Grants and Scholarships:

 ______________________
Outside Grants and Scholarships:

 ______________________


Funds from Other Sources:

Enter any other funds from sources not listed above that will reduce the Amount to Finance.

Funds from Other Sources: ______________________


Non-Standard Tuition:
Check this box to pay an amount other than the standard tuition amounts listed above and enter the amount of Tuition and Fees below.

Non-Standard Tuition Amount: ______________________


Payment Plan Totals

Total Tuition and Fees:
______________________ (Add all Tuition and Fee options above)
(-) Less Financial Aid:

 ______________________ (Add all Financial Aid options above)
Total Amount to Finance:

 ______________________ (Tuition and Fees minus Financial Aid)
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.


Payment Information

Complete your payment options below.
Recurring Direct Debit Option
Please sign me up for the Recurring Direct Debit Option
By checking the above box, I hereby authorize Educational Computer Systems, Inc to automatically deduct monthly payments from the checking or savings account indicated below. This authority will remain in effect until I notify ECSI to terminate or until the Total Payment Plan Budget has been paid in full.
Account Holder Name: ________________________________________
Account Type: Checking Savings
ABA/Routing Number: ___________________________ [Where to Find]
Account Number: ___________________________ [Where to Find]


Recurring Credit Card Option
Please sign me up for the Recurring Credit Card Option
By checking the above box, I hereby authorize Educational Computer Systems, Inc to automatically charge monthly payments of the amount due to the credit card account indicated below. This authority will remain in effect until I notify ECSI to terminate or until the Total Payment Plan Amount has been paid in full.
Card Type: Visa Mastercard Discover
Card Number: ___________________________
Expires: _____-________ (mm-yyyy)
Card Verification (cvv2): ___________ [What's This]
*IMPORTANT NOTICE: If you select the credit card payment option, your card account will be assessed a payment processing fee equal to 3.95% + $1.00 on the amount charged.