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

ECSI c/o Southwestern 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

Social Security Number:
___________________________________________________________
Name (First MI Last):

 ___________________________________________________________
Address 1:

 ___________________________________________________________
Address 2:

 ___________________________________________________________
City/State/Zip:

 ___________________________________________________________
Email:

 ___________________________________________________________
Home Phone:

 ___________________________________________________________
Work Phone:

 ___________________________________________________________
Fax Phone:

 ___________________________________________________________
Cell Phone:

 ___________________________________________________________

Person Financially Responsible

Social Security Number:
___________________________________________________________
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 Start Date End Date Sign Up By
10 Month Plan (T0910) 10 06/01/2009 03/01/2010 08/21/2009
5 Month Fall Plan (T09F5) 5 06/01/2009 10/01/2009 08/21/2009
4 Month Fall Plan (T09F4) 4 07/01/2009 10/01/2009 08/21/2009
5 Month Spring Plan (T09S5) 5 11/01/2009 03/01/2010 01/10/2010
4 Month Spring Plan (T09S4) 4 01/01/2010 04/01/2010 01/10/2010

Anticipated Costs



Tuition & Fees:
______________________

Please include all fees including tuition, room and board, mandatory and optional fees. See the Tuition and fees Schedule at www.ecsi.net/tpp/g5-worksheet.html for pricing information.


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



Federal Subsidized Stafford Loan:
______________________
Federal Unsubsidized Stafford Loan:

 ______________________
Federal Plus Loan:

 ______________________
Federal Perkins Loan:

 ______________________
All Loans, Grants and Scholarships:

 ______________________


Payment Plan Totals

Total Tuition and Fees:
______________________
(-) Less Financial Aid:

 ______________________
(-) Total Amount to Finance:

 ______________________
Total Amount to Finance:

 ______________________ (Tuition and Fees minus Financial Aid and Deposits)
Monthly Payments:

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

 ______________________
First Payment:†

 ______________________ (Includes months past due and application/participation fee)
Additional Payment:

 ______________________

† - 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.