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

Heartland ECSI c/o University of Scranton TPP Application
PO Box 1278
Wexford, PA 15090

If you need help completing this form, please contact Heartland 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 (T1512) 12 $60.00 05/15/2016 04/15/2017 08/10/2016
10 Month Plan (T1510) 10 $60.00 07/15/2016 04/15/2017 09/10/2016
4 Month Fall Plan (T15F4) 4 $35.00 09/15/2016 12/15/2016 10/10/2016
4 Month Spring Plan (T15S4) 4 $35.00 01/15/2017 04/15/2017 02/10/2017

Student Status

* Note: A full-time student may take up to 18 credits during the fall or spring semester at the above tuition rates. Undergraduate students taking more than 18 credits during the fall or spring semester will be billed on a per credit basis for any credit(s) exceeding the limit. The rate is $1072 per credit. This per credit tuition amount will be added to the "Amount to Finance" based on the number of credits chosen per semester.

Number of Fall Credits: ____________
 
Fall Tuition:
Undergraduate Students ($20,881)
 
Fall Housing:
Class B (Freshman Housing Residence Halls) ($4,177)
Class A (Redington, Gavigan, Elizabeth Ann Seton, Katharine Drexel, Condron) ($4,417)
Class AA Double (Mulberry Plaza) (Upperclass Students only) ($4,417)
Class AA Single (Mulberry Plaza, Madison Square & Montrone and Pilarz Hall) (Upperclass Students only) ($4,856)
 
Fall Meal Plan:
Standard Food Program (Unlimited Meal Plan) (Mandatory for Freshman) ($2,955)
Flex Plus Food Program (Unlimited Meal Plan) (Mandatory for Freshman) ($3,055)
Standard Food Program (14-Meal Plan) ($2,496)
Flex Plus Food Program (14-Meal Plan) ($2,596)
Standard Food Program (10-Meal Plan) ($2,045)
Flex Plus Food Program (10-Meal Plan) ($2,145)
 
 
Number of Spring Credits: ____________
 
Spring Tuition:
Undergraduate Students ($20,881)
 
Spring Housing:
Class B (Freshman Housing Residence Halls) ($4,177)
Class A (Redington, Gavigan, Elizabeth Ann Seton, Katharine Drexel, Condron) ($4,417)
Class AA Double (Mulberry Plaza) (Upperclass Students only) ($4,417)
Class AA Single (Mulberry Plaza, Madison Square & Montrone and Pilarz Hall) (Upperclass Students only) ($4,856)
 
Spring Meal Plan:
Standard Food Program (Unlimited Meal Plan) (Mandatory for Freshman) ($2,955)
Flex Plus Food Program (Unlimited Meal Plan) (Mandatory for Freshman) ($3,055)
Standard Food Program (14-Meal Plan) ($2,496)
Flex Plus Food Program (14-Meal Plan) ($2,596)
Standard Food Program (10-Meal Plan) ($2,045)
Flex Plus Food Program (10-Meal Plan) ($2,145)


Student Status (continued)

* Note: A full-time student may take up to 18 credits during the fall or spring semester at the above tuition rates. Undergraduate students taking more than 18 credits during the fall or spring semester will be billed on a per credit basis for any credit(s) exceeding the limit. The rate is $1072 per credit. This per credit tuition amount will be added to the "Amount to Finance" based on the number of credits chosen per semester.

Number of Intersession Credits: ____________

Intersession Tuition: Registered credits for Intersession will generate their own tuition invoice. They will be assessed at the $1072 per credit rate. Please select credits to include in budget.

Intersession Housing: There is no additional cost for Intersession Housing
 
Intersession Meal Plan: Resident Students - Enrolled for Classes or Playing a Winter Sport will be assessed for a Meal Plan.
Food Program (Unlimited Meal Plan) ($738)
Food Program (14-Meal Plan) ($589)
Food Program (10-Meal Plan) ($432)


Mandatory Fees: (Select all that apply)

Fall University Fee ($200)
Spring University Fee ($200)
Intersession University Fee ($25)
New Resident Room Damage Deposit ($200)


Optional Fees: (Select all that apply)

Orientation Fee - New Freshman enrolled during Academic Year 2016/17 ($275)
Orientation Fee - Transfer enrolled during Academic Year 2016/17 ($200)
Commencement Fee - Students graduating during Academic Year 2016/17 ($250)
Fall Lab Fees - as applicable to registered coursework: ______________________
Spring Lab Fees - as applicable to registered coursework: ______________________


Financial Aid & Direct Payments to the University:

Please enter the total amount of financial aid received and any direct payments that will be made to the University by semester. These figures will allow you to alter the monthly payment amount calculated below. Note: Do Not enter your Work Study funds.


Fall Scholarships, Grants and Loans (student or parent):
______________________
Fall Payments made directly to the University:

 ______________________
Spring Scholarships, Grants and Loans (student or parent):

 ______________________
Spring Payments made directly to the University:

 ______________________


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
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